Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5490 | OR |
N | 111NN1001X | Nutrition | 5490 | OR |
N | 111NR0400X | Rehabilitation Chiropractor | 5490 | OR |
N | 111NS0005X | Chiropractic Sports Physician | 5490 | OR |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 5490 | OR |
NPI | 1366876195 |
---|---|
Provider Name | Dr. Matthew Richard Tompkins |
First Address | Bend, OR 97701-3894 |
Second Address | Bend, OR 97701-4376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2013 |
Last Update Date | 16/08/2018 |