Provider Demographics
NPI:1659343952
Name:THOMPSON, MICHAEL S (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
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 1:549 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1333
Mailing Address - Country:US
Mailing Address - Phone:859-431-4430
Mailing Address - Fax:859-431-9560
Practice Address - Street 1:549 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1333
Practice Address - Country:US
Practice Address - Phone:859-431-4430
Practice Address - Fax:859-431-9560
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85036432Medicaid
KY6083901Medicare PIN
KYU73965Medicare UPIN