Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1089 | AL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2317 | AL |
NPI | 1396856183 |
---|---|
Provider Name | Mr. Mark Anthony Thompson |
First Address | Meridianville, AL 35759 |
Second Address | Meridianville, AL 35759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70923 | BCBS (01) | AL |
T68595 | (02) |