Provider Demographics
NPI:1851797179
Name:THOMPSON, JUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:THOMPSON
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 1:3624 W ANTHEM WAY STE C110
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0456
Mailing Address - Country:US
Mailing Address - Phone:623-551-9950
Mailing Address - Fax:623-551-2454
Practice Address - Street 1:3624 W ANTHEM WAY STE C110
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0456
Practice Address - Country:US
Practice Address - Phone:623-551-9950
Practice Address - Fax:623-551-2454
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9200562-1202111N00000X
AZ8503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty