Provider Demographics
NPI:1609321389
Name:KINNEAR, JEFFREY (POM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KINNEAR
Suffix:
Gender:M
Credentials:POM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 W 8TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4711
Mailing Address - Country:US
Mailing Address - Phone:814-823-1641
Mailing Address - Fax:
Practice Address - Street 1:2131 W 8TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4711
Practice Address - Country:US
Practice Address - Phone:814-823-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist