Provider Demographics
NPI:1255316709
Name:THOMAS, DWAYNE E II (DC)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:E
Last Name:THOMAS
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 1:5527 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5503
Mailing Address - Country:US
Mailing Address - Phone:704-568-2447
Mailing Address - Fax:704-568-2591
Practice Address - Street 1:5527 MONROE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212
Practice Address - Country:US
Practice Address - Phone:704-568-2447
Practice Address - Fax:704-568-2591
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08844OtherBLUE CROSS/BLUE SHIELD
NC7908844Medicaid
NCT64524Medicare UPIN
NC08844OtherBLUE CROSS/BLUE SHIELD