Provider Demographics
NPI:1366955288
Name:THOMPSON, MATTHEW G (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 E BLUE HILL RD
Mailing Address - Street 2:P.O. BOX 326
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5312
Mailing Address - Country:US
Mailing Address - Phone:207-374-2186
Mailing Address - Fax:207-374-5235
Practice Address - Street 1:1199 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1134
Practice Address - Country:US
Practice Address - Phone:859-737-5800
Practice Address - Fax:859-737-5801
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2546111N00000X
KY5551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100495640Medicaid