Provider Demographics
NPI:1003959297
Name:KINNEY, SCOTT E (D C)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:KINNEY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SMITH ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4345
Mailing Address - Country:US
Mailing Address - Phone:707-462-3997
Mailing Address - Fax:707-462-2051
Practice Address - Street 1:500 W SMITH ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4345
Practice Address - Country:US
Practice Address - Phone:707-462-3997
Practice Address - Fax:707-462-2051
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0238650Medicare ID - Type UnspecifiedCCHIROPRACTOR