Healthcare Provider Details

I. General information

NPI: 1144307398
Provider Name (Legal Business Name): THOMAS P MCKAY JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 NW BROAD ST. SUITE 400
SOUTHERN PINES NC
28387
US

IV. Provider business mailing address

133 LAUREL OAK LN
PINEBLUFF NC
28373-8020
US

V. Phone/Fax

Practice location:
  • Phone: 910-693-3700
  • Fax: 910-693-3709
Mailing address:
  • Phone: 910-281-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: