=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821378167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ANTHONY MCKENNA D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2011
-----------------------------------------------------
Last Update Date | 01/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2111 W SWANN AVE SUITE 104
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-2477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-253-5969
-----------------------------------------------------
Fax | 813-253-5848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2111 W SWANN AVE SUITE 104
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-2477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-253-5969
-----------------------------------------------------
Fax | 813-253-5848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR008854
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------