MEDICARE: KINCAID CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6143	CO

General Provider Information

NPI Number	:	1790019776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINCAID CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	4038 S TIMBERLINE RD
Second Line	:	SUITE 120
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6031
Country	:	US
Telephone Number	:	970-267-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4038 S TIMBERLINE RD
Second Line	:	SUITE 120
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-6031
Country	:	US
Telephone Number	:	970-267-9600
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/PRESIDENT
Name	:	DR. CASEY M KINCAID
Credential	:	DC
Telephone Number	:	970-267-9600

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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