Provider Demographics
NPI:1780777888
Name:THOMPSON, JEFFEREY (DC)
Entity type:Individual
Prefix:
First Name:JEFFEREY
Middle Name:
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 1:901 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1529
Mailing Address - Country:US
Mailing Address - Phone:740-523-8888
Mailing Address - Fax:740-532-1796
Practice Address - Street 1:4123 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2341
Practice Address - Country:US
Practice Address - Phone:502-333-0604
Practice Address - Fax:502-290-9734
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY249422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0892173Medicaid
OH0892173Medicaid
OH35988Medicare UPIN