Provider Demographics
NPI:1154180677
Name:MCKENZIE, BRANDON R (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:R
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:R
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, PLLC
Mailing Address - Street 1:39949 GARFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4301
Mailing Address - Country:US
Mailing Address - Phone:586-286-1112
Mailing Address - Fax:586-412-3673
Practice Address - Street 1:39949 GARFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4301
Practice Address - Country:US
Practice Address - Phone:586-286-1112
Practice Address - Fax:586-412-3673
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301011032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor