Provider Demographics
NPI:1861796138
Name:MCMILLON-DANTLEY, CANDACE TENISE (DC)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:TENISE
Last Name:MCMILLON-DANTLEY
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 1:2804 REMINGTON GREEN CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1550
Mailing Address - Country:US
Mailing Address - Phone:850-385-4494
Mailing Address - Fax:850-298-6054
Practice Address - Street 1:1249 STRONG RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-5248
Practice Address - Country:US
Practice Address - Phone:850-298-6082
Practice Address - Fax:850-627-2786
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004415200Medicaid