Provider Demographics
NPI:1689839573
Name:ICP&R ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ICP&R ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-772-3232
Mailing Address - Street 1:1404 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3774
Mailing Address - Country:US
Mailing Address - Phone:239-772-3232
Mailing Address - Fax:239-458-3272
Practice Address - Street 1:1404 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 110
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3774
Practice Address - Country:US
Practice Address - Phone:239-772-3232
Practice Address - Fax:239-458-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5040111N00000X
FLOS4407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty