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General NPI Number Information
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NPI Number | 1619057767
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Entity Type | Organization
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Legal Business Name | KINNISON CHIROPRACTIC INC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2001 N 4TH ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-4227
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Country | US
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Telephone | 928-526-5797
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Fax | 928-222-1775
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Provider Business Mailing Address
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Address Line | 2001 N 4TH ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-4227
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Country | US
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Telephone | 928-526-5797
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Fax | 928-222-1775
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | GEOFFREY P KINNISON
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Credential | D.C.
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Telephone | 928-526-5797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6024
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License Number State | AZ
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