Provider Demographics
NPI:1396856183
Name:THOMPSON, MARK ANTHONY (DC FACO)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:11411 HWY 231 NORTH
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759
Mailing Address - Country:US
Mailing Address - Phone:256-828-5050
Mailing Address - Fax:256-828-5050
Practice Address - Street 1:11411 HWY 231 N
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759
Practice Address - Country:US
Practice Address - Phone:256-828-5050
Practice Address - Fax:256-828-5050
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1089111N00000X
AL2317111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL70923OtherBCBS
T68595Medicare UPIN