Provider Demographics
NPI:1255497046
Name:MCKEON CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:MCKEON CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MCKEON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:863-676-2717
Mailing Address - Street 1:2433 STATEROAD 60 EAST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-5122
Mailing Address - Country:US
Mailing Address - Phone:863-676-2717
Mailing Address - Fax:863-676-3390
Practice Address - Street 1:2433 STATEROAD 60 EAST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-5122
Practice Address - Country:US
Practice Address - Phone:863-676-2717
Practice Address - Fax:863-676-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty