Provider Demographics
NPI:1821258377
Name:THOMPSON, BEVERLY ANN (DC; QME)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC; QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3037
Mailing Address - Country:US
Mailing Address - Phone:626-797-2323
Mailing Address - Fax:
Practice Address - Street 1:1911 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3037
Practice Address - Country:US
Practice Address - Phone:626-797-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor