Provider Demographics
NPI:1407028475
Name:KEVIN MCKENZIE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:KEVIN MCKENZIE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-729-0034
Mailing Address - Street 1:928 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7326
Mailing Address - Country:US
Mailing Address - Phone:301-729-0034
Mailing Address - Fax:301-729-0034
Practice Address - Street 1:928 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7326
Practice Address - Country:US
Practice Address - Phone:301-729-0034
Practice Address - Fax:301-729-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1552PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM509Medicare PIN