Healthcare Provider Details

I. General information

NPI: 1740753094
Provider Name (Legal Business Name): SCOTT MACKENZIE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 E CAMELBACK RD STE 155
PHOENIX AZ
85018-8349
US

IV. Provider business mailing address

4040 E CAMELBACK RD STE 155
PHOENIX AZ
85018-8349
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-2095
  • Fax:
Mailing address:
  • Phone: 602-956-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8729
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: