Provider Demographics
NPI:1396829867
Name:PORTER, AIMEE MCKINNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:MCKINNEY
Last Name:PORTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 30TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3301
Mailing Address - Country:US
Mailing Address - Phone:510-444-2772
Mailing Address - Fax:510-444-2773
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3301
Practice Address - Country:US
Practice Address - Phone:510-444-2772
Practice Address - Fax:510-444-2773
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04719Medicare UPIN