Provider Demographics
NPI:1467460501
Name:THOMPSON, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15230 NE 24TH ST STE 1-S
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5540
Mailing Address - Country:US
Mailing Address - Phone:425-827-2225
Mailing Address - Fax:425-283-4192
Practice Address - Street 1:15230 NE 24TH ST STE 1-S
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5540
Practice Address - Country:US
Practice Address - Phone:425-827-2225
Practice Address - Fax:425-283-4192
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA188390OtherL&I NUMBER
WA8803424Medicare ID - Type UnspecifiedGROUP ID
WA188390OtherL&I NUMBER