Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5215 | MN |
NPI | 1003040247 |
---|---|
Provider Name | Dr. Kelly Thompson |
First Address | Delano, MN 55328-9404 |
Second Address | Delano, MN 55328-9404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2009 |
Last Update Date | 18/12/2009 |