Provider Demographics
NPI:1265511836
Name:KINNARD, JAMES A
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:KINNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 SORRENTO DRIVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020
Mailing Address - Country:US
Mailing Address - Phone:573-873-9800
Mailing Address - Fax:573-873-9800
Practice Address - Street 1:71 SORRENTO DRIVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020
Practice Address - Country:US
Practice Address - Phone:573-873-9800
Practice Address - Fax:573-873-9800
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005258111N00000X
AL890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT00725Medicare UPIN