Provider Demographics
NPI:1306507330
Name:BREWER, MCKENZY LYNN (DC)
Entity type:Individual
Prefix:
First Name:MCKENZY
Middle Name:LYNN
Last Name:BREWER
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 1:1602 E STARR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4312
Mailing Address - Country:US
Mailing Address - Phone:936-560-5441
Mailing Address - Fax:
Practice Address - Street 1:1602 E STARR AVE STE 201
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4312
Practice Address - Country:US
Practice Address - Phone:936-560-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor