Provider Demographics
NPI:1750017067
Name:THOMPSON, TYRON R (DC)
Entity type:Individual
Prefix:DR
First Name:TYRON
Middle Name:R
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 1:28-07 ZACHARY TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3927
Mailing Address - Country:US
Mailing Address - Phone:201-220-1125
Mailing Address - Fax:
Practice Address - Street 1:1550 LEMOINE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5608
Practice Address - Country:US
Practice Address - Phone:551-313-9689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00792400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty