Provider Demographics
NPI:1427453844
Name:THOMPSON, ANGELIA KAY TUCKER (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELIA
Middle Name:KAY TUCKER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ANGELIA
Other - Middle Name:KAY
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:211 N 23RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3984
Mailing Address - Country:US
Mailing Address - Phone:870-537-0763
Mailing Address - Fax:870-359-6094
Practice Address - Street 1:211 N 23RD ST STE 3
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3984
Practice Address - Country:US
Practice Address - Phone:870-537-0763
Practice Address - Fax:870-359-6094
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor