Provider Demographics
NPI:1700996162
Name:THOMSON, MARK CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:THOMSON
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 1:5755 VALENTINE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7407
Mailing Address - Country:US
Mailing Address - Phone:805-650-1297
Mailing Address - Fax:805-644-4527
Practice Address - Street 1:5755 VALENTINE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7407
Practice Address - Country:US
Practice Address - Phone:805-650-1297
Practice Address - Fax:805-644-1501
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14256Medicare PIN