Provider Demographics
NPI:1700063757
Name:MCDOUGAL, KEVIN DUNCAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DUNCAN
Last Name:MCDOUGAL
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 1:2407 S CONGRESS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5505
Mailing Address - Country:US
Mailing Address - Phone:512-442-2777
Mailing Address - Fax:512-442-2963
Practice Address - Street 1:2407 S CONGRESS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5505
Practice Address - Country:US
Practice Address - Phone:512-442-2777
Practice Address - Fax:512-442-2963
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10741111N00000X
UT68563151202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L11388Medicare PIN
TX8L11388Medicare PIN