Provider Demographics
NPI:1790757920
Name:THOMPSON, DARLA GAYLE (DC)
Entity Type:Individual
Prefix:
First Name:DARLA
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 1:2050 NORTH LOOP W
Mailing Address - Street 2:STE 223
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8128
Mailing Address - Country:US
Mailing Address - Phone:713-880-1555
Mailing Address - Fax:713-263-1058
Practice Address - Street 1:2050 NORTH LOOP W
Practice Address - Street 2:STE 223
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8128
Practice Address - Country:US
Practice Address - Phone:713-880-1555
Practice Address - Fax:713-263-1058
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06054769Medicaid
TX29JDOtherBLUE CROSS/ BLUE SHIELD
TX1509652OtherUNITED HEALTHCARE
TX1509652OtherUNITED HEALTHCARE
U62033Medicare UPIN