Provider Demographics
NPI:1881335230
Name:MAHONEY, KENZIE (DC)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:MAHONEY
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 1:356 MOUNTAIN VIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5989
Mailing Address - Country:US
Mailing Address - Phone:802-655-2664
Mailing Address - Fax:
Practice Address - Street 1:356 MOUNTAIN VIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5989
Practice Address - Country:US
Practice Address - Phone:802-655-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0134173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor