Provider Demographics
NPI:1477662542
Name:MCKENZIE, EDWARD D (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:MCKENZIE
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 1:928 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1222
Mailing Address - Country:US
Mailing Address - Phone:785-364-4151
Mailing Address - Fax:785-364-2774
Practice Address - Street 1:928 W 6TH ST
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1222
Practice Address - Country:US
Practice Address - Phone:785-364-4151
Practice Address - Fax:785-364-2774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023557OtherBCBS
KS10870827OtherCAQH
KS10870827OtherCAQH
KST71301Medicare UPIN