Provider Demographics
NPI:1508165416
Name:THOMSON, LISA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-2603
Mailing Address - Country:US
Mailing Address - Phone:562-907-7700
Mailing Address - Fax:562-907-5511
Practice Address - Street 1:12101 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-2603
Practice Address - Country:US
Practice Address - Phone:562-907-7700
Practice Address - Fax:562-907-5511
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor