Provider Demographics
NPI:1881955896
Name:MCKENZIE, SKIPTON TRACEY (MA)
Entity type:Individual
Prefix:MR
First Name:SKIPTON
Middle Name:TRACEY
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8770 N KILBUCK RD
Mailing Address - Street 2:
Mailing Address - City:MONROE CENTER
Mailing Address - State:IL
Mailing Address - Zip Code:61052-9721
Mailing Address - Country:US
Mailing Address - Phone:815-319-1312
Mailing Address - Fax:
Practice Address - Street 1:8770 N KILBUCK RD
Practice Address - Street 2:
Practice Address - City:MONROE CENTER
Practice Address - State:IL
Practice Address - Zip Code:61052-9721
Practice Address - Country:US
Practice Address - Phone:815-319-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor