Provider Demographics
NPI:1609569086
Name:WELCH, MACKENZIE JOHN (DC)
Entity Type:Individual
Prefix:MR
First Name:MACKENZIE
Middle Name:JOHN
Last Name:WELCH
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 1:5700 E LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453
Mailing Address - Country:US
Mailing Address - Phone:352-317-8837
Mailing Address - Fax:352-799-3320
Practice Address - Street 1:803 S BROAD ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601
Practice Address - Country:US
Practice Address - Phone:352-799-3433
Practice Address - Fax:352-799-3320
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor