Healthcare Provider Details

I. General information

NPI: 1306165774
Provider Name (Legal Business Name): MCKENNA HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 N HENDERSON RD
ARLINGTON VA
22203-2486
US

IV. Provider business mailing address

4141 N HENDERSON RD
ARLINGTON VA
22203-2486
US

V. Phone/Fax

Practice location:
  • Phone: 571-402-2225
  • Fax: 703-276-3339
Mailing address:
  • Phone: 571-402-2225
  • Fax: 703-276-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number0104556788
License Number StateVA

VIII. Authorized Official

Name: DR. JOSEPH WILLIAM MCKENNA
Title or Position: OWNER
Credential: D.C.
Phone: 571-402-2225