Provider Demographics
NPI:1518062389
Name:THOMPSON, TRISTIN R (DC)
Entity Type:Individual
Prefix:
First Name:TRISTIN
Middle Name:R
Last Name:THOMPSON
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:P.O. BOX 51
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048
Mailing Address - Country:US
Mailing Address - Phone:859-586-9777
Mailing Address - Fax:859-689-6133
Practice Address - Street 1:2950 HEBRON PARK DRIVE, SUITE E
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048
Practice Address - Country:US
Practice Address - Phone:859-586-9777
Practice Address - Fax:859-689-6133
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6064001Medicare PIN
U38566Medicare UPIN