Provider Demographics
NPI:1114536869
Name:ANDERSEN, THOMAS KERVIN II (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KERVIN
Last Name:ANDERSEN
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 LEAD MINE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3326
Mailing Address - Country:US
Mailing Address - Phone:919-781-8830
Mailing Address - Fax:919-781-1678
Practice Address - Street 1:4517 LEAD MINE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3326
Practice Address - Country:US
Practice Address - Phone:919-781-8830
Practice Address - Fax:919-781-1678
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor