Individual
BOUNTHONG TOBY THEPSOUMPHONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, LMT, BS
Contact information
Practice address
621 E KIMBERLY RD, DAVENPORT, IA 52807-1623
(563) 359-1985
Mailing address
2909 HAWTHORNE DR APT A, BETTENDORF, IA 52722-2971
(717) 339-6676
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
115283
IA
225700000X
Massage Therapist
094910
IA
225700000X
Massage Therapist
MT-0004508
DE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/15/2021
Last updated
07/11/2022
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