Provider Demographics
NPI:1477516169
Name:MCKIM, RAYMOND KEITH (DC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:KEITH
Last Name:MCKIM
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 1:2023 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6311
Mailing Address - Country:US
Mailing Address - Phone:208-467-5756
Mailing Address - Fax:208-467-1368
Practice Address - Street 1:2023 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6311
Practice Address - Country:US
Practice Address - Phone:208-467-5756
Practice Address - Fax:208-467-1368
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-459111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002702400Medicaid
ID002702400Medicaid