Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0104001181 | VA |
NPI | 1225112857 |
---|---|
Provider Name | Dr. Shandon Joseph Thompson |
First Address | Ashburn, VA 20147-5667 |
Second Address | Ashburn, VA 20147-5667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 30/10/2009 |