Provider Demographics
NPI:1912968850
Name:THOMSON, GLEN ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:ANDREW
Last Name:THOMSON
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 1:2801 WESTERN AVE
Mailing Address - Street 2:APT 1115
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1181
Mailing Address - Country:US
Mailing Address - Phone:206-319-7088
Mailing Address - Fax:
Practice Address - Street 1:1100 NE 47TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4686
Practice Address - Country:US
Practice Address - Phone:206-527-0123
Practice Address - Fax:206-527-0133
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor