Provider Demographics
NPI:1013086354
Name:MCKINNEY, GREGG S (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:S
Last Name:MCKINNEY
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 1:34 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2112
Mailing Address - Country:US
Mailing Address - Phone:860-633-0611
Mailing Address - Fax:860-657-8601
Practice Address - Street 1:34 CONCORD ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2112
Practice Address - Country:US
Practice Address - Phone:860-633-0611
Practice Address - Fax:860-657-8601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050000251CT01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000251CT01OtherBCBS
CTOV4669OtherLANDMARK
CT030-000251OtherHEALTH SOURCE
CT0516797OtherUS HEALTHCARE
CT0982469OtherAETNA HEALTH PLANS
1013086354OtherNPI
1013086354OtherNPI
CTT22958Medicare UPIN