Provider Demographics
NPI:1629167234
Name:MCKINSEY, MYLES W (DC)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:W
Last Name:MCKINSEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1853
Mailing Address - Country:US
Mailing Address - Phone:636-583-2202
Mailing Address - Fax:636-583-2202
Practice Address - Street 1:212 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084
Practice Address - Country:US
Practice Address - Phone:636-583-2202
Practice Address - Fax:636-583-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODRC 2000153196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO146071OtherBLUE CROSS/BLUE SHIELD
MO146071OtherBLUE CROSS/BLUE SHIELD