Provider Demographics
NPI:1023147600
Name:MCKENZIE, SHEILA G (DC)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:G
Last Name:MCKENZIE
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 1:1065 E LONG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4912
Mailing Address - Country:US
Mailing Address - Phone:248-524-2223
Mailing Address - Fax:248-524-1398
Practice Address - Street 1:1065 E LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4912
Practice Address - Country:US
Practice Address - Phone:248-524-2223
Practice Address - Fax:248-524-1398
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP26577FOtherBLUE CARE NETWORK
MI950F350090OtherBLUE CROSS BLUE SHEILD
MI11283300OtherCAQH
MI11283300OtherCAQH