Provider Demographics
NPI:1578013371
Name:MCKILLIP, CODY JAMES (DC, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:JAMES
Last Name:MCKILLIP
Suffix:
Gender:M
Credentials:DC, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1011 KAIPALAOA ST APT 404
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6117
Mailing Address - Country:US
Mailing Address - Phone:309-737-9553
Mailing Address - Fax:
Practice Address - Street 1:91-1001 KAIMALIE ST # 106
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6247
Practice Address - Country:US
Practice Address - Phone:808-637-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
HIDC-1574-0111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer