Provider Demographics
NPI:1053719328
Name:THOMPSON, BRYAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
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 1:63 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-9626
Mailing Address - Country:US
Mailing Address - Phone:801-721-1155
Mailing Address - Fax:
Practice Address - Street 1:63 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-8402
Practice Address - Country:US
Practice Address - Phone:801-721-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9091013-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor