Provider Demographics
NPI:1053634717
Name:LOPEZ, KEVIN MARC (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARC
Last Name:LOPEZ
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 1:16244 S MILITARY TRL
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6534
Mailing Address - Country:US
Mailing Address - Phone:561-637-3779
Mailing Address - Fax:561-637-6997
Practice Address - Street 1:16244 S MILITARY TRL
Practice Address - Street 2:SUITE 470
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-637-3779
Practice Address - Fax:561-637-6997
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor