Individual provider Active NPI

Nate Edward Kinnison, D.C

  • Rehabilitation Chiropractor
  • Wentzville, MO
National Provider Identifier
1285249581
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
2020029175 Issued in MO
Practice address
111 W Allen St
Wentzville, MO 63385-1402
Phone
(636) 686-0201
Fax
(636) 486-4350
NPI assigned
Sep 14, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X 2020029175 MO Primary

Addresses

Primary practice location

111 W Allen St
Wentzville, MO 63385-1402

Mailing address

111 W Allen St
Wentzville, MO 63385-1402
Phone (636) 686-0201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kinnison Chiropractic, LLC Rehabilitation CurrentSince Aug 15, 2022 Accepting new patients
Back Pain Center LLC CurrentSince May 12, 2021 Accepting new patients

Locations

2530 Highway K
O Fallon, MO 63368
Phone (636) 978-5511

111 W Allen St
Wentzville, MO 63385
Phone (636) 686-0201

905 Main Plaza Dr
Wentzville, MO 63385
Phone (636) 856-1260

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1285249581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W ALLEN ST",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633851402",
            "telephone_number": "636-686-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W ALLEN ST",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633851402",
            "telephone_number": "636-686-0201",
            "fax_number": "636-486-4350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINNISON",
        "first_name": "NATE",
        "middle_name": "EDWARD",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-14",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "MO",
            "license": "2020029175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wentzville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.