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General NPI Number Information
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NPI Number | 1477151363
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Entity Type | Organization
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Legal Business Name | KINNISON CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 905 MAIN PLAZA DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-1168
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Country | US
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Telephone | 636-856-1260
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Fax | 636-856-1245
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Provider Business Mailing Address
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Address Line | 2017 EMERALD CREST CT
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5404
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Country | US
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Telephone | 573-768-1250
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Fax |
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Authorized Official
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Title or Position | DR. NATE KINNISON
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Name | NATE EDWARD KINNISON
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Credential |
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Telephone | 573-768-1250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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