Provider Demographics
NPI:1063881753
Name:HUBERT, MACKENZIE SARA (DC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:SARA
Last Name:HUBERT
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 1:556 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-6526
Mailing Address - Country:US
Mailing Address - Phone:908-216-5487
Mailing Address - Fax:
Practice Address - Street 1:524 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:908-216-5487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor