Provider Demographics
NPI:1427115880
Name:THOMPSON, ROSLYN DELORES (DC)
Entity type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:DELORES
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 1:4724 DOBERMAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8724
Mailing Address - Country:US
Mailing Address - Phone:407-295-9572
Mailing Address - Fax:407-295-9572
Practice Address - Street 1:4100 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2205
Practice Address - Country:US
Practice Address - Phone:407-293-8890
Practice Address - Fax:407-293-8891
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8368111N00000X
FL1757532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3816044 00Medicaid
FL3816044 00Medicaid
FL70777Medicare ID - Type UnspecifiedMEDICARE