Provider Demographics
NPI:1023239340
Name:THOMPSON, PAMELA JOY (DC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOY
Last Name:THOMPSON
Suffix:
Gender:F
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:PO BOX 44
Mailing Address - Street 2:717 SOUTH BLVD
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-0044
Mailing Address - Country:US
Mailing Address - Phone:608-356-0177
Mailing Address - Fax:608-356-3265
Practice Address - Street 1:717 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-0044
Practice Address - Country:US
Practice Address - Phone:608-356-0177
Practice Address - Fax:608-356-3265
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
70246Medicare ID - Type Unspecified