Provider Demographics
NPI:1447983598
Name:MAESAKA, THOMPSON (DC)
Entity type:Individual
Prefix:DR
First Name:THOMPSON
Middle Name:
Last Name:MAESAKA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 LINCOLN DR APT 314
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2703
Mailing Address - Country:US
Mailing Address - Phone:952-356-2295
Mailing Address - Fax:
Practice Address - Street 1:10900 HAMPSHIRE AVE S STE 120
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-2699
Practice Address - Country:US
Practice Address - Phone:732-595-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6994111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty