Provider Demographics
NPI:1922162288
Name:THOMPSON, THOMAS J (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
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 1:250 N 18TH AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1482
Mailing Address - Country:US
Mailing Address - Phone:608-325-1999
Mailing Address - Fax:608-325-1997
Practice Address - Street 1:250 N 18TH AVE
Practice Address - Street 2:STE 104
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1482
Practice Address - Country:US
Practice Address - Phone:608-325-1999
Practice Address - Fax:608-325-1997
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI3280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU50710Medicare UPIN
WI70903Medicare ID - Type Unspecified
WI70903Medicare PIN