Provider Demographics
NPI:1578869681
Name:MCKENZIE, DRU DOUGLAS (LMP)
Entity Type:Individual
Prefix:
First Name:DRU
Middle Name:DOUGLAS
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2836
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-2836
Mailing Address - Country:US
Mailing Address - Phone:509-888-9989
Mailing Address - Fax:509-888-9592
Practice Address - Street 1:313 E. WOODIN AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816
Practice Address - Country:US
Practice Address - Phone:509-888-9989
Practice Address - Fax:509-888-9592
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist