Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2020029175 | MO |
NPI | 1285249581 |
---|---|
Provider Name | Nate Edward Kinnison |
First Address | Wentzville, MO 63385-1168 |
Second Address | Wentzville, MO 63385-1168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |