Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 21880 | CA |
NPI | 1124332218 |
---|---|
Provider Name | Dr. Mark Thompson |
First Address | Berkeley, CA 94702-1167 |
Second Address | San Francisco, CA 94114-3309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 30/07/2010 |