Provider Demographics
NPI:1033280797
Name:THOMPSON, JIMMY D (DC)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:D
Last Name:THOMPSON
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:PO BOX 13627
Mailing Address - Street 2:600 PINE FOREST DRIVE SUITE 111
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72111-6911
Mailing Address - Country:US
Mailing Address - Phone:501-851-8938
Mailing Address - Fax:501-851-6313
Practice Address - Street 1:600 PINE FOREST DRIVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72111-6911
Practice Address - Country:US
Practice Address - Phone:501-851-8938
Practice Address - Fax:501-851-6313
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59903Medicare ID - Type Unspecified
T69499Medicare UPIN