Provider Demographics
NPI:1003880337
Name:KINKEAD, LAURA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:KINKEAD
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 1:6145 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2605
Mailing Address - Country:US
Mailing Address - Phone:727-849-5077
Mailing Address - Fax:727-849-7901
Practice Address - Street 1:6145 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2605
Practice Address - Country:US
Practice Address - Phone:727-849-5077
Practice Address - Fax:727-849-7901
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6612111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380322800Medicaid
FLU44143Medicare UPIN
FL380322800Medicaid