Terry Dean Thompson, D.C., C.C.S.P.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

038.004727 Issued in IL

Practice address

117 S Main St
Palestine, IL 62451-1265

Phone

(618) 586-5454

Fax

(618) 586-9470

NPI assigned

Mar 14, 2006

Last updated

Jan 10, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231545600000",
    "number": "1205804499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 S MAIN ST",
            "city": "PALESTINE",
            "state": "IL",
            "postal_code": "624511265",
            "telephone_number": "618-586-5454",
            "fax_number": "618-586-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S MAIN ST",
            "city": "PALESTINE",
            "state": "IL",
            "postal_code": "624511265",
            "telephone_number": "618-586-5454",
            "fax_number": "618-586-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "TERRY",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "D.C., C.C.S.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2009-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-004727",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "IL",
            "license": "038.004727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "038004727",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEIN",
            "identifier": "371140723",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Jo Harrington
• McKenna Jones
• Abbey McCord, M.S., CCC-SLP
• Palestine Cusd 3
• Madelyn Taylor, RN
• Kelly Walker, MS, RD, LDN

• Sports Physician Chiropractor in Palestine, IL
• Providers in Palestine, IL by specialty
• Sports Physician Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.