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NPI Code Detail

MEDICARE: DR. CANDICE MATHIS DC

MEDICARE: DR. CANDICE MATHIS DC
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
1111N00000XChiropractor2014002030MO
2111N00000XChiropractorCHR0007097CO

General Provider Information

NPI Number : 1174949861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CANDICE MATHIS DC
Provider Business Mailing Address
First Line : 2061 COLLIER CORPORATE PKWY
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-6701
Country : US
Telephone Number : 719-580-5565
Fax Number :
Provider Business Practice Location Address
First Line : 2061 COLLIER CORPORATE PKWY
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-6701
Country : US
Telephone Number : 719-580-5565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2014
Last Update Date : 09/02/2020

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