Provider Demographics
NPI:1770093312
Name:THOMPSON, ADAM JAMES (LAC, LMT)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JAMES
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1055 N LOGAN ST APT 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3033
Mailing Address - Country:US
Mailing Address - Phone:612-990-1563
Mailing Address - Fax:
Practice Address - Street 1:535 16TH ST STE 280
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4223
Practice Address - Country:US
Practice Address - Phone:303-371-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018561225700000X
COACU.0002087171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist