Provider Demographics
NPI:1558743203
Name:THOMPSON FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:THOMPSON FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:269-684-7822
Mailing Address - Street 1:208 GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2202
Mailing Address - Country:US
Mailing Address - Phone:269-684-7822
Mailing Address - Fax:
Practice Address - Street 1:208 GRANT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2202
Practice Address - Country:US
Practice Address - Phone:269-684-7822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003761111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14-4315151Medicaid
MI32580001Medicare UPIN