Provider Demographics
NPI:1194939827
Name:KINNEY, JODI LYNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:LYNETTE
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 1:100 W VETERANS HWY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3435
Mailing Address - Country:US
Mailing Address - Phone:732-833-9000
Mailing Address - Fax:732-833-9932
Practice Address - Street 1:100 W VETERANS HWY
Practice Address - Street 2:SUITE 7
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3435
Practice Address - Country:US
Practice Address - Phone:732-833-9000
Practice Address - Fax:732-833-9932
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00571800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ371425018OtherTAX ID
NJMC-063350Medicare ID - Type Unspecified