MEDICARE: KENICA THOMASON D.C., L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3931	OK

General Provider Information

NPI Number	:	1760702260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENICA THOMASON D.C., L.L.C.

Provider Business Mailing Address
First Line	:	1809 COMMONS CIR
Second Line	:	A
City	:	YUKON
State	:	OK
Zip	:	73099-7314
Country	:	US
Telephone Number	:	405-577-6268
Fax Number	:	405-577-6371

Provider Business Practice Location Address
First Line	:	1809 COMMONS CIR
Second Line	:	A
City	:	YUKON
State	:	OK
Zip	:	73099-7314
Country	:	US
Telephone Number	:	405-577-6268
Fax Number	:	405-577-6371

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. KENICA AMANDA THOMASON
Credential	:	D.C.
Telephone Number	:	405-577-6268

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	03/22/2013

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