Provider Demographics
NPI:1790019776
Name:KINCAID CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:KINCAID CHIROPRACTIC PLLC
Other - Org Name:ADVANTAGE CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-267-9600
Mailing Address - Street 1:4038 S TIMBERLINE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6031
Mailing Address - Country:US
Mailing Address - Phone:970-267-9600
Mailing Address - Fax:
Practice Address - Street 1:4038 S TIMBERLINE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6031
Practice Address - Country:US
Practice Address - Phone:970-267-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty