Provider Demographics
NPI:1548382120
Name:MCKAY, JOHN K JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:MCKAY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:509 JACKSON ST
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0627
Mailing Address - Country:US
Mailing Address - Phone:912-537-2564
Mailing Address - Fax:912-538-9391
Practice Address - Street 1:509 JACKSON ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4720
Practice Address - Country:US
Practice Address - Phone:912-537-2564
Practice Address - Fax:912-537-9391
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO1572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU21413Medicare ID - Type Unspecified