Provider Demographics
NPI:1992854475
Name:THOMPSON, BRADLEY D (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
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 1:4062 HARNEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2828
Mailing Address - Country:US
Mailing Address - Phone:619-297-9355
Mailing Address - Fax:
Practice Address - Street 1:4062 HARNEY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2828
Practice Address - Country:US
Practice Address - Phone:619-297-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18979Medicare ID - Type Unspecified
CAU30872Medicare UPIN