Provider Demographics
NPI:1649501479
Name:THOMASON, KENICA AMANDA (DC)
Entity type:Individual
Prefix:DR
First Name:KENICA
Middle Name:AMANDA
Last Name:THOMASON
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 1:1809 COMMONS CIR
Mailing Address - Street 2:A
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099
Mailing Address - Country:US
Mailing Address - Phone:405-577-6268
Mailing Address - Fax:405-577-6371
Practice Address - Street 1:1809 COMMONS CIR
Practice Address - Street 2:A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-577-6268
Practice Address - Fax:405-577-6371
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor