Provider Demographics
NPI:1710228945
Name:MCKINNEY, KRIS R (LAC)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:R
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 W 96TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1462
Mailing Address - Country:US
Mailing Address - Phone:773-615-7581
Mailing Address - Fax:
Practice Address - Street 1:79 E 16TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-5520
Practice Address - Country:US
Practice Address - Phone:312-842-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist