Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC010995 | PA |
NPI | 1003206558 |
---|---|
Provider Name | Zachary Mckendree |
First Address | Massillon, OH 44647-5469 |
Second Address | Massillon, OH 44647-5469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2015 |
Last Update Date | 30/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4567 | LICENSE (01) | OH |