Provider Demographics
NPI:1639201742
Name:THOMPSON, WALTER BRUNDAGE (DC)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:BRUNDAGE
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 1:222 W MISSION AVE
Mailing Address - Street 2:SUITE 132
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2344
Mailing Address - Country:US
Mailing Address - Phone:509-328-0775
Mailing Address - Fax:509-328-0778
Practice Address - Street 1:222 W MISSION AVE
Practice Address - Street 2:SUITE 132
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2344
Practice Address - Country:US
Practice Address - Phone:509-328-0775
Practice Address - Fax:509-328-0778
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG 000301607OtherMEDICARE ID-PIN
WAG000301607Medicare PIN
WAG 000301607OtherMEDICARE ID-PIN