Provider Demographics
NPI:1376715151
Name:MURRAY, KEVIN M (LIC AC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:MURRAY
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 TEAWADDLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9517
Mailing Address - Country:US
Mailing Address - Phone:413-549-9960
Mailing Address - Fax:
Practice Address - Street 1:CANYON RANCH
Practice Address - Street 2:165 KEMBLE ST. BOX 2170
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240
Practice Address - Country:US
Practice Address - Phone:413-549-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist