Provider Demographics
NPI:1285249581
Name:KINNISON, NATE EDWARD (DC)
Entity type:Individual
Prefix:
First Name:NATE
Middle Name:EDWARD
Last Name:KINNISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1402
Mailing Address - Country:US
Mailing Address - Phone:636-686-0201
Mailing Address - Fax:
Practice Address - Street 1:111 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1402
Practice Address - Country:US
Practice Address - Phone:636-686-0201
Practice Address - Fax:636-486-4350
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029175111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation