Provider Demographics
NPI:1336212737
Name:MCKENZIE, KEVIN M
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7326
Mailing Address - Country:US
Mailing Address - Phone:301-729-0034
Mailing Address - Fax:301-729-0034
Practice Address - Street 1:928 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7326
Practice Address - Country:US
Practice Address - Phone:301-729-0034
Practice Address - Fax:301-729-0034
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1552PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor