Provider Demographics
NPI:1871714931
Name:THOMPSON, STEPHEN R (DACM, DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:DACM, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2620
Mailing Address - Country:US
Mailing Address - Phone:612-448-4434
Mailing Address - Fax:
Practice Address - Street 1:3115 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2620
Practice Address - Country:US
Practice Address - Phone:612-448-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor