Healthcare Provider Details

I. General information

NPI: 1184176927
Provider Name (Legal Business Name): NATHANIAL PAUL MCKEE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHANNON RAE MCKEE D.C. D.PL.AC., RAC

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S STATE RD SUITE C
DAVISON MI
48423
US

IV. Provider business mailing address

1510 S STATE RD SUITE C
DAVISON MI
48423
US

V. Phone/Fax

Practice location:
  • Phone: 810-223-2439
  • Fax: 810-616-5900
Mailing address:
  • Phone: 810-223-2439
  • Fax: 810-616-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: