Provider Demographics
NPI:1740241058
Name:MCVAY, KIRK EVAN (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:EVAN
Last Name:MCVAY
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 1:5900 HIATUS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330
Mailing Address - Country:US
Mailing Address - Phone:954-252-7744
Mailing Address - Fax:954-252-7556
Practice Address - Street 1:5900 HIATUS RD
Practice Address - Street 2:STE 100
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330
Practice Address - Country:US
Practice Address - Phone:954-252-7744
Practice Address - Fax:954-252-7556
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70972AMedicare ID - Type Unspecified
U20068Medicare UPIN