Provider Demographics
NPI:1235732975
Name:VETTER, MACKENZIE (DC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:VETTER
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 1:450 CORPORATE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6094
Mailing Address - Country:US
Mailing Address - Phone:406-755-3014
Mailing Address - Fax:
Practice Address - Street 1:450 CORPORATE DR STE 108
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6094
Practice Address - Country:US
Practice Address - Phone:406-755-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor