MEDICARE: MCKEON CHIROPRACTIC CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH9107	FL

General Provider Information

NPI Number	:	1255497046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKEON CHIROPRACTIC CLINIC PA

Provider Business Mailing Address
First Line	:	2433 STATEROAD 60 EAST
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33898-5122
Country	:	US
Telephone Number	:	863-676-2717
Fax Number	:	863-676-3390

Provider Business Practice Location Address
First Line	:	2433 STATEROAD 60 EAST
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33898-5122
Country	:	US
Telephone Number	:	863-676-2717
Fax Number	:	863-676-3390

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS DANIEL MCKEON JR.
Credential	:	D.C.
Telephone Number	:	863-676-2717

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/24/2016

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