Provider Demographics
NPI:1851623391
Name:MAIN, DAVID THOMPSON (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMPSON
Last Name:MAIN
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 1:1118 N AVALON BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-3520
Mailing Address - Country:US
Mailing Address - Phone:310-522-5811
Mailing Address - Fax:
Practice Address - Street 1:1118 N AVALON BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-3520
Practice Address - Country:US
Practice Address - Phone:310-522-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor