Provider Demographics
NPI:1407189434
Name:MCMAHON, KENT (DC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S 42ND ST STE 2B
Mailing Address - Street 2:2
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6218
Mailing Address - Country:US
Mailing Address - Phone:618-242-8100
Mailing Address - Fax:618-242-8101
Practice Address - Street 1:1009 S 42ND ST STE 2B
Practice Address - Street 2:2
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6218
Practice Address - Country:US
Practice Address - Phone:618-242-8100
Practice Address - Fax:618-242-8101
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6240001Medicare PIN