Provider Demographics
NPI:1174685002
Name:INGRAM, KINDRA J (DC)
Entity Type:Individual
Prefix:DR
First Name:KINDRA
Middle Name:J
Last Name:INGRAM
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 1:8555 16TH ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2816
Mailing Address - Country:US
Mailing Address - Phone:301-562-0390
Mailing Address - Fax:301-562-0392
Practice Address - Street 1:8555 16TH ST
Practice Address - Street 2:SUITE 800
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2816
Practice Address - Country:US
Practice Address - Phone:301-562-0390
Practice Address - Fax:301-562-0392
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030046111NR0400X
MD03394111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV05651Medicare UPIN
MDG2044A01Medicare PIN