Provider Demographics
NPI:1710321096
Name:MCKENNA, PAUL RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:MCKENNA
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 1:1390 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4304
Mailing Address - Country:US
Mailing Address - Phone:408-460-6119
Mailing Address - Fax:
Practice Address - Street 1:1390 S WINCHESTER BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4304
Practice Address - Country:US
Practice Address - Phone:408-460-6119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor