Healthcare Provider Details

I. General information

NPI: 1356038467
Provider Name (Legal Business Name): THOMAS ALLEN KINNEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N PEORIA ST
CHICAGO IL
60607-2609
US

IV. Provider business mailing address

16 N PEORIA ST
CHICAGO IL
60607-2609
US

V. Phone/Fax

Practice location:
  • Phone: 312-346-9355
  • Fax:
Mailing address:
  • Phone: 312-346-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038013930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: