Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3996 | OR |
NPI | 1003121567 |
---|---|
Provider Name | Kip Thompson |
First Address | Beaverton, OR 97005-2562 |
Second Address | Beaverton, OR 97005-2562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2010 |
Last Update Date | 16/01/2017 |