Provider Demographics
NPI:1033291604
Name:KINKEAD, DANIEL J (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:KINKEAD
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 1:3614 E SOUTHERN AVE # A105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2509
Mailing Address - Country:US
Mailing Address - Phone:480-838-6696
Mailing Address - Fax:480-838-9392
Practice Address - Street 1:3614 E SOUTHERN AVE
Practice Address - Street 2:SUITE A-105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2509
Practice Address - Country:US
Practice Address - Phone:602-833-3199
Practice Address - Fax:602-833-3190
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0932910OtherBCBS ID#
AZZDC4294Medicare PIN