Provider Demographics
NPI:1477730190
Name:THOMPSON, BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC
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 225
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0003
Mailing Address - Country:US
Mailing Address - Phone:662-349-4494
Mailing Address - Fax:662-349-4495
Practice Address - Street 1:7464 TCHULAHOMA RD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9249
Practice Address - Country:US
Practice Address - Phone:662-349-4494
Practice Address - Fax:662-349-4495
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3045182OtherBLUE CROSS BLUE SHIELD
MS1C350044428OtherRAILROAD MEDICARE
TN3045182OtherBLUE CROSS BLUE SHIELD