Provider Demographics
NPI:1417970914
Name:KINNEAVY, ELIZABETH A (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KINNEAVY
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 1:2770 DAGNY WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8017
Mailing Address - Country:US
Mailing Address - Phone:303-604-2987
Mailing Address - Fax:303-604-2997
Practice Address - Street 1:2770 DAGNY WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8017
Practice Address - Country:US
Practice Address - Phone:303-604-2987
Practice Address - Fax:303-604-2997
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO$$$$$$$$$OtherSOCIAL SECURITY NUMBNER
COC489128Medicare PIN