Provider Demographics
NPI:1912369349
Name:MCKINNEY, ANNETTE ELIZABETH (DC LAC MSOM)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ELIZABETH
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:DC LAC MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3145
Mailing Address - Country:US
Mailing Address - Phone:630-510-7799
Mailing Address - Fax:
Practice Address - Street 1:1600 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3145
Practice Address - Country:US
Practice Address - Phone:630-510-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001439171100000X
IL038012941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist