Provider Demographics
NPI:1053865824
Name:SHUFORD, MACKENZIE (DC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:SHUFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SALTY DOG LN
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-6011
Mailing Address - Country:US
Mailing Address - Phone:540-645-3888
Mailing Address - Fax:
Practice Address - Street 1:216 SALTY DOG LN
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-6011
Practice Address - Country:US
Practice Address - Phone:540-645-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33661111N00000X
NC5017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor