Provider Demographics
NPI:1982736609
Name:HAMPLE, MICHAEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:HAMPLE
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 1:11919 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3911
Mailing Address - Country:US
Mailing Address - Phone:763-757-1660
Mailing Address - Fax:763-757-4108
Practice Address - Street 1:11919 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3911
Practice Address - Country:US
Practice Address - Phone:763-757-1660
Practice Address - Fax:763-757-4108
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2654111N00000X
ME761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231218OtherACN
MN62396HAOtherBCBS
MN2732289-00Medicaid
MN62396HAOtherBCBS
MN350000753Medicare ID - Type Unspecified