Provider Demographics
NPI:1033249214
Name:KINNEAR, MICHAEL K (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:KINNEAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30821 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4901
Mailing Address - Country:US
Mailing Address - Phone:253-839-8608
Mailing Address - Fax:253-941-6821
Practice Address - Street 1:30821 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4901
Practice Address - Country:US
Practice Address - Phone:253-839-8608
Practice Address - Fax:253-941-6821
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA88915OtherLABOR & INDUSTRIES
WA88915OtherLABOR & INDUSTRIES