Provider Demographics
NPI:1700011665
Name:CLINE, SHANDY KENT (LAC,DOM)
Entity Type:Individual
Prefix:DR
First Name:SHANDY
Middle Name:KENT
Last Name:CLINE
Suffix:
Gender:M
Credentials:LAC,DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WALK ABOUT LN
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6702
Mailing Address - Country:US
Mailing Address - Phone:828-495-4149
Mailing Address - Fax:
Practice Address - Street 1:74 8TH ST SE STE 235
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1121
Practice Address - Country:US
Practice Address - Phone:828-302-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235171100000X
NM862171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist