Provider Demographics
NPI:1730379249
Name:MCKENZIE-HENNESSY CHIROPRACTIC PC
Entity type:Organization
Organization Name:MCKENZIE-HENNESSY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-939-9489
Mailing Address - Street 1:7121 W BELL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8555
Mailing Address - Country:US
Mailing Address - Phone:623-939-9489
Mailing Address - Fax:623-939-1934
Practice Address - Street 1:7121 W BELL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8555
Practice Address - Country:US
Practice Address - Phone:623-939-9489
Practice Address - Fax:623-939-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT41937Medicare UPIN
AZT41713Medicare UPIN