Provider Demographics
NPI:1043538135
Name:INCLEDON CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:INCLEDON CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAREN
Authorized Official - Last Name:INCLEDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-865-8390
Mailing Address - Street 1:6609 WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-0910
Mailing Address - Country:US
Mailing Address - Phone:561-865-8390
Mailing Address - Fax:561-865-1730
Practice Address - Street 1:6609 WOOLBRIGHT RD
Practice Address - Street 2:SUITE 414
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-0910
Practice Address - Country:US
Practice Address - Phone:561-865-8390
Practice Address - Fax:561-865-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3818900-00Medicaid
FL604421OtherUNITED HEALTHCARE
FLP2586587OtherOXFORD
FLDR3227OtherRAILROAD MEDICARE
FL53941OtherBLUE CROSS
FL1043538135Medicare UPIN