Provider Demographics
NPI:1346577749
Name:THOMPSON, RENEE NICOLE (DC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:NICOLE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S LITCHFIELD RD STE 220-R
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1513
Mailing Address - Country:US
Mailing Address - Phone:480-597-4344
Mailing Address - Fax:602-497-2476
Practice Address - Street 1:1300 S LITCHFIELD RD STE 220-R
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1513
Practice Address - Country:US
Practice Address - Phone:480-597-4344
Practice Address - Fax:602-497-2476
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0059714111N00000X
AZ8756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor