Provider Demographics
NPI:1861453219
Name:THOMPSON, MICHAEL RALPH (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RALPH
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 1:143 E 400 N
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4725
Mailing Address - Country:US
Mailing Address - Phone:801-295-7801
Mailing Address - Fax:801-295-8996
Practice Address - Street 1:143 E 400 N
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4725
Practice Address - Country:US
Practice Address - Phone:801-295-7801
Practice Address - Fax:801-295-8996
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT147517-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor