Provider Demographics
NPI:1487946919
Name:THOMPSON, RUSSELL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:JOSEPH
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:629 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2834
Mailing Address - Country:US
Mailing Address - Phone:949-240-1334
Mailing Address - Fax:949-240-4434
Practice Address - Street 1:629 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2834
Practice Address - Country:US
Practice Address - Phone:949-240-1334
Practice Address - Fax:949-240-4434
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor