Provider Demographics
NPI:1942208996
Name:THOMPSON, RANDALL JAY (DC)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:JAY
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 1:257-B AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-9266
Mailing Address - Country:US
Mailing Address - Phone:479-667-9760
Mailing Address - Fax:479-667-1606
Practice Address - Street 1:257 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-9200
Practice Address - Country:US
Practice Address - Phone:479-667-9760
Practice Address - Fax:479-667-1602
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U557Medicare ID - Type Unspecified