Healthcare Provider Details

I. General information

NPI: 1164722427
Provider Name (Legal Business Name): LAURA A. KINKEAD, D.C., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 GRAND BLVD
NEW PORT RICHEY FL
34652-2605
US

IV. Provider business mailing address

6145 GRAND BLVD
NEW PORT RICHEY FL
34652-2605
US

V. Phone/Fax

Practice location:
  • Phone: 727-849-5077
  • Fax: 727-849-7901
Mailing address:
  • Phone: 727-849-5077
  • Fax: 727-849-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA ANN KINKEAD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 727-849-5077