Provider Demographics
NPI:1922436864
Name:THOMPSON, JUSTIN (DC)
Entity Type:Individual
Prefix:
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 1:106 E CRANDALL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3628
Mailing Address - Country:US
Mailing Address - Phone:870-704-4072
Mailing Address - Fax:870-743-9881
Practice Address - Street 1:106 E CRANDALL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3628
Practice Address - Country:US
Practice Address - Phone:870-704-4072
Practice Address - Fax:870-743-9881
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor