Provider Demographics
NPI:1952453276
Name:KINNEY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KINNEY CHIROPRACTIC, INC.
Other - Org Name:KINNEY CHIROPRACTIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, QME
Authorized Official - Phone:530-344-9411
Mailing Address - Street 1:4535 MISSOURI FLAT RD STE 1F
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6808
Mailing Address - Country:US
Mailing Address - Phone:530-344-9411
Mailing Address - Fax:
Practice Address - Street 1:4535 MISSOURI FLAT RD STE 1F
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6808
Practice Address - Country:US
Practice Address - Phone:530-344-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINNEY CHIROPRACTIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0114651Medicare UPIN