Provider Demographics
NPI:1437346855
Name:DAVID W. KINNISON
Entity Type:Organization
Organization Name:DAVID W. KINNISON
Other - Org Name:KINNISON FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DAV ID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KINNISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-605-8583
Mailing Address - Street 1:1740 RUFE SNOW DR STE B
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5669
Mailing Address - Country:US
Mailing Address - Phone:817-605-8363
Mailing Address - Fax:817-605-8364
Practice Address - Street 1:1740 RUFE SNOW DR STE B
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5669
Practice Address - Country:US
Practice Address - Phone:817-605-8363
Practice Address - Fax:817-605-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00957VMedicare PIN