Provider Demographics
NPI:1477151363
Name:KINNISON CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:KINNISON CHIROPRACTIC, LLC
Other - Org Name:BACK PAIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DR. NATE KINNISON
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KINNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-768-1250
Mailing Address - Street 1:2017 EMERALD CREST CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5404
Mailing Address - Country:US
Mailing Address - Phone:573-768-1250
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN PLAZA DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1168
Practice Address - Country:US
Practice Address - Phone:636-856-1260
Practice Address - Fax:636-856-1245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINNISON CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-13
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty