Provider Demographics
NPI:1518006428
Name:THOMPSON, CHARLES L (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
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 1:225 N BENTON DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1575
Mailing Address - Country:US
Mailing Address - Phone:320-252-2225
Mailing Address - Fax:320-252-2159
Practice Address - Street 1:225 N BENTON DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1575
Practice Address - Country:US
Practice Address - Phone:320-252-2225
Practice Address - Fax:320-252-2159
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2753111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN63870THOtherBLUE CROSS AND BLUE SHIEL
MN63870THOtherBLUE CROSS AND BLUE SHIEL