Provider Demographics
NPI:1316798317
Name:THOMPSON CHIROPRACTIC
Entity type:Organization
Organization Name:THOMPSON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-948-1960
Mailing Address - Street 1:7780 SADDLEBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9852
Mailing Address - Country:US
Mailing Address - Phone:903-948-1960
Mailing Address - Fax:
Practice Address - Street 1:5646 WOODBINE RD STE 3
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8794
Practice Address - Country:US
Practice Address - Phone:850-378-9857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty