Provider Demographics
NPI:1235387820
Name:KINNINGER, ADAM JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOSEPH
Last Name:KINNINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4972
Mailing Address - Country:US
Mailing Address - Phone:828-580-1750
Mailing Address - Fax:828-580-1751
Practice Address - Street 1:20 S MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4972
Practice Address - Country:US
Practice Address - Phone:828-580-1750
Practice Address - Fax:828-580-1751
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-0500207Q00000X, 207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911783Medicaid