Provider Demographics
NPI:1972672780
Name:THOMPSON, ERIC NATHAN (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:NATHAN
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 1:146 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1207
Mailing Address - Country:US
Mailing Address - Phone:606-845-0588
Mailing Address - Fax:606-845-0599
Practice Address - Street 1:146 CLARK ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1207
Practice Address - Country:US
Practice Address - Phone:606-845-0588
Practice Address - Fax:606-845-0599
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000392107OtherANTHEM PIN NUMBER
KY85001832Medicaid
KY0998001Medicare PIN
KYU86922Medicare UPIN