Provider Demographics
NPI:1912667098
Name:THOMPSON, TAD MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TAD
Middle Name:MICHAEL
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 1:700 KEN PRATT BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6454
Mailing Address - Country:US
Mailing Address - Phone:785-302-8207
Mailing Address - Fax:
Practice Address - Street 1:700 KEN PRATT BLVD STE 108
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6454
Practice Address - Country:US
Practice Address - Phone:785-302-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0008348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor