Provider Demographics
NPI:1730309253
Name:KINCAID CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:KINCAID CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-524-1198
Mailing Address - Street 1:146 RAILROAD ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1948
Mailing Address - Country:US
Mailing Address - Phone:608-524-1198
Mailing Address - Fax:608-524-1187
Practice Address - Street 1:146 RAILROAD ST STE 100A
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1948
Practice Address - Country:US
Practice Address - Phone:608-524-1198
Practice Address - Fax:608-524-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3433-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38908400Medicaid
000070715Medicare UPIN