Provider Demographics
NPI:1356400543
Name:THOMPSON, ROBERT DAVID (DC , CCSP)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC , CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4654
Mailing Address - Country:US
Mailing Address - Phone:609-971-3500
Mailing Address - Fax:609-971-3545
Practice Address - Street 1:424 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-4654
Practice Address - Country:US
Practice Address - Phone:609-971-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00626200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9044802OtherPHCS PROVIDER NUMBER
NJP3395950OtherOXFORD PROVIDER NUMBER
NJ2348312000OtherAMERIHEALTH
NJ4881128OtherCIGNA PROVIDER NUMBER
NJ3646590OtherAETNA PROVIDER NUMBER
NJ0041424Medicaid
NJ550861955OtherBLUE CROSS BLUE SHIELD
NJ3646590OtherAETNA PROVIDER NUMBER
NJ550861955OtherBLUE CROSS BLUE SHIELD