Healthcare Provider Details

I. General information

NPI: 1730258989
Provider Name (Legal Business Name): CLINTON LANE KINNEAR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 GRAND AVE #100
CARLSBAD CA
92008-2370
US

IV. Provider business mailing address

PO BOX 1176
CARDIFF CA
92007-7176
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-3200
  • Fax: 760-729-3201
Mailing address:
  • Phone: 760-908-9053
  • Fax: 760-729-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104002014
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: