Provider Demographics
NPI:1891887550
Name:THOMPSON, TAMARA DENISE (DC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DENISE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:DENISE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1409 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801
Mailing Address - Country:US
Mailing Address - Phone:620-342-8700
Mailing Address - Fax:620-342-8595
Practice Address - Street 1:1409 STANTON ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801
Practice Address - Country:US
Practice Address - Phone:620-342-8700
Practice Address - Fax:620-342-8595
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060365Medicare ID - Type Unspecified