Healthcare Provider Details

I. General information

NPI: 1760702260
Provider Name (Legal Business Name): KENICA THOMASON D.C., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 COMMONS CIR A
YUKON OK
73099-7314
US

IV. Provider business mailing address

1809 COMMONS CIR A
YUKON OK
73099-7314
US

V. Phone/Fax

Practice location:
  • Phone: 405-577-6268
  • Fax: 405-577-6371
Mailing address:
  • Phone: 405-577-6268
  • Fax: 405-577-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3931
License Number StateOK

VIII. Authorized Official

Name: DR. KENICA AMANDA THOMASON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 405-577-6268