Provider Demographics
NPI:1487350005
Name:MCKELVY, ROBIN (LAC, LMT, DACHM)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MCKELVY
Suffix:
Gender:M
Credentials:LAC, LMT, DACHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11380
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1380
Mailing Address - Country:US
Mailing Address - Phone:928-910-6153
Mailing Address - Fax:
Practice Address - Street 1:450 W GOODWIN ST STE 103B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3781
Practice Address - Country:US
Practice Address - Phone:928-910-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-24179225700000X
AZLAC-011396171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist