Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CHIR008590 | GA |
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR008590 | GA |
NPI | 1053621961 |
---|---|
Provider Name | Dr. Mitchell Mckinney |
First Address | Sandysprings, GA 30350 |
Second Address | Atlanta, GA 30331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2010 |
Last Update Date | 13/10/2010 |