Provider Demographics
NPI:1780751230
Name:MCKINNEY, BRUCE A (DC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
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 1:7702 PRESTON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219
Mailing Address - Country:US
Mailing Address - Phone:502-961-0007
Mailing Address - Fax:502-961-0005
Practice Address - Street 1:7702 PRESTON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219
Practice Address - Country:US
Practice Address - Phone:502-961-0007
Practice Address - Fax:502-961-0005
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85042737002Medicaid
44047Medicare UPIN
KY85042737002Medicaid