Healthcare Provider Details

I. General information

NPI: 1518094648
Provider Name (Legal Business Name): KATHLEEN J. MCKAY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN MCKAY ZAHEDI D.C.

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 A REICH
MARSING ID
83639
US

IV. Provider business mailing address

PO BOX 271
MARSING ID
83639-0271
US

V. Phone/Fax

Practice location:
  • Phone: 208-896-5520
  • Fax: 208-896-9920
Mailing address:
  • Phone: 208-896-5520
  • Fax: 208-896-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA 1039
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: