Provider Demographics
NPI:1104088087
Name:KINNEY, HEATHER J (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:J
Last Name:KINNEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19365 SW 65TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9196
Mailing Address - Country:US
Mailing Address - Phone:503-486-5199
Mailing Address - Fax:503-486-5190
Practice Address - Street 1:19365 SW 65TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9196
Practice Address - Country:US
Practice Address - Phone:503-486-5199
Practice Address - Fax:503-486-5190
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor