Provider Demographics
NPI:1922196625
Name:MACKENZIE, NANCY C (DC)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:C
Last Name:MACKENZIE
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 1:4670 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8717
Mailing Address - Country:US
Mailing Address - Phone:850-995-5773
Mailing Address - Fax:850-995-5713
Practice Address - Street 1:4670 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8717
Practice Address - Country:US
Practice Address - Phone:850-995-5773
Practice Address - Fax:850-995-5713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000CH5926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5293Medicare UPIN