Provider Demographics
NPI:1114105392
Name:THOMAS, KANDYCE T'NEAL (DC)
Entity Type:Individual
Prefix:DR
First Name:KANDYCE
Middle Name:T'NEAL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S TRADE ST
Mailing Address - Street 2:STE 108
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5774
Mailing Address - Country:US
Mailing Address - Phone:704-543-5508
Mailing Address - Fax:704-943-1551
Practice Address - Street 1:10440 PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8504
Practice Address - Country:US
Practice Address - Phone:704-534-3496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor