Provider Demographics
NPI:1851680953
Name:MACKENZIE, BRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:MACKENZIE
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 1:8611 HILLCREST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4207
Mailing Address - Country:US
Mailing Address - Phone:972-741-1555
Mailing Address - Fax:
Practice Address - Street 1:8611 HILLCREST AVE STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4207
Practice Address - Country:US
Practice Address - Phone:972-741-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor