Provider Demographics
NPI:1639849391
Name:KNIGHT, MCKENZIE REED (DC)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:REED
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 CRAIG DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-3119
Mailing Address - Country:US
Mailing Address - Phone:269-449-4203
Mailing Address - Fax:
Practice Address - Street 1:5110 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2512
Practice Address - Country:US
Practice Address - Phone:269-449-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor