Provider Demographics
NPI:1508803032
Name:MACKENZIE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MACKENZIE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-887-1515
Mailing Address - Street 1:205 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7838
Mailing Address - Country:US
Mailing Address - Phone:336-887-1515
Mailing Address - Fax:336-887-3966
Practice Address - Street 1:205 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7838
Practice Address - Country:US
Practice Address - Phone:336-887-1515
Practice Address - Fax:336-887-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1210261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908625Medicaid
NC7543341OtherAETNA ID#
NC08625OtherBCBS ID#
NC330321OtherA.C.N. ID#
NC1306827977Medicare ID - Type UnspecifiedINDIVIDUAL NPI#
NC08625OtherBCBS ID#
NC7543341OtherAETNA ID#