Provider Demographics
NPI:1316910920
Name:THOMPSON, MICHAEL COREY (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:COREY
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 1:5203 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-9608
Mailing Address - Country:US
Mailing Address - Phone:281-261-5321
Mailing Address - Fax:281-362-0233
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:#100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:281-362-0006
Practice Address - Fax:281-362-0233
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC9130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1965Medicare ID - Type Unspecified
TXV07960Medicare UPIN