Provider Demographics
NPI:1093810939
Name:PINCKNEY, MICHAEL REX (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:REX
Last Name:PINCKNEY
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 1:507 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6740
Mailing Address - Country:US
Mailing Address - Phone:708-354-9599
Mailing Address - Fax:708-354-9799
Practice Address - Street 1:507 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6740
Practice Address - Country:US
Practice Address - Phone:708-354-9599
Practice Address - Fax:708-354-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00071845OtherRAILROAD MEDICARE
IL4923193OtherBLUE CROSS BLUE SHIELD
IL606504OtherACN
IL4400474OtherUNITED HEALTH CARE
ILP00071845OtherRAILROAD MEDICARE
IL4400474OtherUNITED HEALTH CARE