Provider Demographics
NPI:1902019789
Name:THOMPSON, JEAN ELLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ELLEN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 TWIN KNOLLS RD STE 219
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3264
Mailing Address - Country:US
Mailing Address - Phone:443-745-8905
Mailing Address - Fax:104-740-1117
Practice Address - Street 1:5513 TWIN KNOLLS RD STE 219
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3264
Practice Address - Country:US
Practice Address - Phone:410-740-1112
Practice Address - Fax:104-740-1117
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor