Provider Demographics
NPI:1215141221
Name:KINKEADE, DARYL LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:LAWRENCE
Last Name:KINKEADE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-5422
Mailing Address - Country:US
Mailing Address - Phone:941-474-1268
Mailing Address - Fax:
Practice Address - Street 1:1791 WINSTAN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4980
Practice Address - Country:US
Practice Address - Phone:941-270-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVO7708Medicare UPIN