Provider Demographics
NPI:1780713131
Name:THOMPSON, JOHN ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
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 1:7330 FERN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4971
Mailing Address - Country:US
Mailing Address - Phone:318-798-5557
Mailing Address - Fax:318-798-5558
Practice Address - Street 1:7330 FERN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4971
Practice Address - Country:US
Practice Address - Phone:318-798-5557
Practice Address - Fax:318-798-5558
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1117111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X406Medicare UPIN
LA5BC03Medicare PIN