Provider Demographics
NPI:1942013883
Name:SPORT KINETIC CHIROPRACTIC
Entity type:Organization
Organization Name:SPORT KINETIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:MCKOWN
Authorized Official - Last Name:MCKOWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-966-5011
Mailing Address - Street 1:309 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-1434
Mailing Address - Country:US
Mailing Address - Phone:276-966-5011
Mailing Address - Fax:
Practice Address - Street 1:309 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1434
Practice Address - Country:US
Practice Address - Phone:276-966-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center