Provider Demographics
NPI:1992744494
Name:PHILLIP THOMPSON DC INC PS
Entity type:Organization
Organization Name:PHILLIP THOMPSON DC INC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/V. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-939-0906
Mailing Address - Street 1:914 D ST NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4163
Mailing Address - Country:US
Mailing Address - Phone:253-939-0906
Mailing Address - Fax:253-939-3381
Practice Address - Street 1:914 D ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4163
Practice Address - Country:US
Practice Address - Phone:253-939-0906
Practice Address - Fax:253-939-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAUBI: 602 101 394 000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8856087Medicare ID - Type UnspecifiedMEDICARE GROUP ID #