Provider Demographics
NPI:1164695003
Name:NANCY C MACKENZIE DC
Entity Type:Organization
Organization Name:NANCY C MACKENZIE DC
Other - Org Name:WOODBINE FAMILY CHIROPRACTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-995-5773
Mailing Address - Street 1:4670 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8717
Mailing Address - Country:US
Mailing Address - Phone:850-995-5773
Mailing Address - Fax:
Practice Address - Street 1:4670 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8717
Practice Address - Country:US
Practice Address - Phone:850-995-5773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000CH5926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5293Medicare UPIN