Provider Demographics
NPI:1699849679
Name:THOMPSON, EMILY GAYLE (DC)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:GAYLE
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 1:625 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-1404
Mailing Address - Country:US
Mailing Address - Phone:651-460-6560
Mailing Address - Fax:651-460-6749
Practice Address - Street 1:625 8TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1404
Practice Address - Country:US
Practice Address - Phone:651-460-6560
Practice Address - Fax:651-460-6749
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV02445Medicare UPIN