Provider Demographics
NPI:1790970127
Name:JESSICA DAWN THOMPSON D.C., P.C.
Entity Type:Organization
Organization Name:JESSICA DAWN THOMPSON D.C., P.C.
Other - Org Name:ADVANCED FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-772-8311
Mailing Address - Street 1:1020 KEN PRATT BLVD
Mailing Address - Street 2:UNIT G
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6375
Mailing Address - Country:US
Mailing Address - Phone:303-772-8311
Mailing Address - Fax:303-772-8558
Practice Address - Street 1:1020 KEN PRATT BLVD
Practice Address - Street 2:UNIT G
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6375
Practice Address - Country:US
Practice Address - Phone:303-772-8311
Practice Address - Fax:303-772-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO808831Medicare PIN