Provider Demographics
NPI:1053342311
Name:THOMPSON, PHILLIP A (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 D ST NE
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8856088Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#