Provider Demographics
NPI:1003206558
Name:MCKENDREE, ZACHARY
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:MCKENDREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 FEDERAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-5469
Mailing Address - Country:US
Mailing Address - Phone:330-833-2085
Mailing Address - Fax:330-833-2067
Practice Address - Street 1:276 FEDERAL AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-5469
Practice Address - Country:US
Practice Address - Phone:330-833-2085
Practice Address - Fax:330-833-2067
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4567OtherLICENSE