MEDICARE: DR. GREGG S MCKINNEY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	050000251CT01	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050000251CT01	OTHER	CT	BCBS
2	OV4669	OTHER	CT	LANDMARK
3	030-000251	OTHER	CT	HEALTH SOURCE
4	0516797	OTHER	CT	US HEALTHCARE
5	0982469	OTHER	CT	AETNA HEALTH PLANS
6	1013086354	OTHER		NPI

General Provider Information

NPI Number	:	1013086354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG S MCKINNEY D.C.

Provider Business Mailing Address
First Line	:	34 CONCORD ST
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2112
Country	:	US
Telephone Number	:	860-633-0611
Fax Number	:	860-657-8601

Provider Business Practice Location Address
First Line	:	34 CONCORD ST
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2112
Country	:	US
Telephone Number	:	860-633-0611
Fax Number	:	860-657-8601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	12/27/2013

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