Provider Demographics
NPI:1528100443
Name:MCKENNEY CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:MCKENNEY CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCKENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-245-8955
Mailing Address - Street 1:5608 SE 113TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-4038
Mailing Address - Country:US
Mailing Address - Phone:352-245-8955
Mailing Address - Fax:352-245-9156
Practice Address - Street 1:5608 SE 113TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4038
Practice Address - Country:US
Practice Address - Phone:352-245-8955
Practice Address - Fax:352-245-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9593Medicare ID - Type UnspecifiedGROUP #