Healthcare Provider Details

I. General information

NPI: 1093810939
Provider Name (Legal Business Name): MICHAEL REX PINCKNEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S LA GRANGE RD
LA GRANGE IL
60525-6740
US

IV. Provider business mailing address

507 S LA GRANGE RD
LA GRANGE IL
60525-6740
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-9599
  • Fax: 708-354-9799
Mailing address:
  • Phone: 708-354-9599
  • Fax: 708-354-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: