Provider Demographics
NPI:1558307629
Name:MCKEON, THOMAS DANIEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DANIEL
Last Name:MCKEON
Suffix:JR
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 1:2433 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-5122
Mailing Address - Country:US
Mailing Address - Phone:863-676-2717
Mailing Address - Fax:863-676-3390
Practice Address - Street 1:2433 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-5122
Practice Address - Country:US
Practice Address - Phone:863-676-2717
Practice Address - Fax:863-676-3390
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7157AMedicare ID - Type Unspecified
FLV08707Medicare UPIN