MEDICARE: DR. DWAYNE E THOMAS II D.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	1534	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08844	OTHER	NC	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255316709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWAYNE E THOMAS II D.C.

Provider Business Mailing Address
First Line	:	5527 MONROE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-5503
Country	:	US
Telephone Number	:	704-568-2447
Fax Number	:	704-568-2591

Provider Business Practice Location Address
First Line	:	5527 MONROE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212
Country	:	US
Telephone Number	:	704-568-2447
Fax Number	:	704-568-2591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	06/15/2018

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