Provider Demographics
NPI:1962503250
Name:KINNISON, GEOFFREY PATRICK (DC)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:PATRICK
Last Name:KINNISON
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 1:2501 N 4TH ST
Mailing Address - Street 2:STE 7A
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3700
Mailing Address - Country:US
Mailing Address - Phone:520-491-9298
Mailing Address - Fax:928-779-2429
Practice Address - Street 1:2001 N 4TH STREET
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-526-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0938270OtherBCBS OF AZ
AZ647672OtherUNITED HEALTHCARE
AZ647672OtherUNITED HEALTHCARE