Provider Demographics
NPI:1518094648
Name:MCKAY, KATHLEEN J (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:MCKAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:MCKAY
Other - Last Name:ZAHEDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:MARSING
Mailing Address - State:ID
Mailing Address - Zip Code:83639-0271
Mailing Address - Country:US
Mailing Address - Phone:208-896-5520
Mailing Address - Fax:208-896-9920
Practice Address - Street 1:7 A REICH
Practice Address - Street 2:
Practice Address - City:MARSING
Practice Address - State:ID
Practice Address - Zip Code:83639
Practice Address - Country:US
Practice Address - Phone:208-896-5520
Practice Address - Fax:208-896-9920
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 1039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1675593Medicare ID - Type Unspecified