Provider Demographics
NPI:1275526873
Name:MCKINZIE, LONNY R (DC)
Entity Type:Individual
Prefix:DR
First Name:LONNY
Middle Name:R
Last Name:MCKINZIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 OLD BULLARD RD.
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8662
Mailing Address - Country:US
Mailing Address - Phone:903-531-2243
Mailing Address - Fax:903-787-8847
Practice Address - Street 1:3600 OLD BULLARD RD
Practice Address - Street 2:SUITE 350
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8650
Practice Address - Country:US
Practice Address - Phone:903-531-2243
Practice Address - Fax:903-787-8847
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
604022OtherBLUE CROSS BLUE SHIELD
604022Medicare ID - Type Unspecified
U05295Medicare UPIN