Provider Demographics
NPI:1629021944
Name:THOMPSON, NOEL S (DC)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:S
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 1:4444 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1820
Mailing Address - Country:US
Mailing Address - Phone:203-374-4393
Mailing Address - Fax:203-371-8584
Practice Address - Street 1:4444 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1820
Practice Address - Country:US
Practice Address - Phone:203-374-4393
Practice Address - Fax:203-371-8584
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004136190Medicaid
CT004136190Medicaid
CTD900075168Medicare PIN