Provider Demographics
NPI:1043753197
Name:MCKINNEY, SETH (DC)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:MCKINNEY
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 1:508 N WABASH ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1709
Mailing Address - Country:US
Mailing Address - Phone:260-563-8476
Mailing Address - Fax:260-563-8477
Practice Address - Street 1:508 N WABASH ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1709
Practice Address - Country:US
Practice Address - Phone:260-563-8476
Practice Address - Fax:260-563-8477
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002942A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor