Provider Demographics
NPI:1396013066
Name:KIP THOMPSON DC LLC
Entity Type:Organization
Organization Name:KIP THOMPSON DC LLC
Other - Org Name:CATALYST CHIROPRACTIC AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-526-8782
Mailing Address - Street 1:13025 SW MILLIKAN WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2562
Mailing Address - Country:US
Mailing Address - Phone:503-526-8782
Mailing Address - Fax:503-526-8721
Practice Address - Street 1:13025 SW MILLIKAN WAY
Practice Address - Street 2:STE 120
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2562
Practice Address - Country:US
Practice Address - Phone:503-526-8782
Practice Address - Fax:503-526-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3996261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center