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General NPI Number Information
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NPI Number | 1255497046
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Entity Type | Organization
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Legal Business Name | MCKEON CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 2433 STATEROAD 60 EAST
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City | LAKE WALES
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State | FL
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Zip | 33898-5122
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Country | US
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Telephone | 863-676-2717
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Fax | 863-676-3390
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Provider Business Mailing Address
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Address Line | 2433 STATEROAD 60 EAST
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City | LAKE WALES
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State | FL
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Zip | 33898-5122
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Country | US
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Telephone | 863-676-2717
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Fax | 863-676-3390
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS DANIEL MCKEON JR.
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Credential | D.C.
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Telephone | 863-676-2717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9107
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License Number State | FL
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