Provider Demographics
NPI:1699053926
Name:MACKENZIE, SEAN ROME (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ROME
Last Name:MACKENZIE
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 1:4255 E PECOS RD
Mailing Address - Street 2:# 3016
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7832
Mailing Address - Country:US
Mailing Address - Phone:480-440-3994
Mailing Address - Fax:
Practice Address - Street 1:4255 E PECOS RD
Practice Address - Street 2:# 3016
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-7832
Practice Address - Country:US
Practice Address - Phone:480-440-3994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor