Provider Demographics
NPI:1811946940
Name:MCNABB, KEVIN L
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:MCNABB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019B S HENDERSON BLVD
Mailing Address - Street 2:STE. 8
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3546
Mailing Address - Country:US
Mailing Address - Phone:903-984-5522
Mailing Address - Fax:903-984-5547
Practice Address - Street 1:2019B S HENDERSON BLVD
Practice Address - Street 2:STE. 8
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3546
Practice Address - Country:US
Practice Address - Phone:903-984-5522
Practice Address - Fax:903-984-5547
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6460111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20687-001Medicaid
TX605939Medicare UPIN
TX609209Medicare ID - Type Unspecified