Provider Demographics
NPI:1053402362
Name:MCKENZIE, JAMES EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:619 S WASHINGTON ST
Mailing Address - Street 2:STE #101
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3090
Mailing Address - Country:US
Mailing Address - Phone:208-883-4300
Mailing Address - Fax:208-883-4311
Practice Address - Street 1:619 S WASHINGTON ST
Practice Address - Street 2:STE #101
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3090
Practice Address - Country:US
Practice Address - Phone:208-883-4300
Practice Address - Fax:208-883-4311
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDCHIA1041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor