Provider Demographics
NPI:1720106875
Name:BRADLEY S THOMPSON FAMILY LIMITED PARTNERSHIP NO ONE
Entity Type:Organization
Organization Name:BRADLEY S THOMPSON FAMILY LIMITED PARTNERSHIP NO ONE
Other - Org Name:BRADLEY S THOMPSON CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:662-349-4494
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671
Mailing Address - Country:US
Mailing Address - Phone:662-349-4494
Mailing Address - Fax:662-349-4495
Practice Address - Street 1:7464 TCHULAHOMA ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-349-4494
Practice Address - Fax:662-349-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS350044428OtherRR MEDICARE
TN3045182OtherBCBS
TN3045182OtherBCBS