Provider Demographics
NPI:1548282965
Name:KINNARD, JEFFERY SHANE (DC)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SHANE
Last Name:KINNARD
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 1:2611 HIGHWAY 44 W
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3725
Mailing Address - Country:US
Mailing Address - Phone:352-726-0554
Mailing Address - Fax:352-728-3885
Practice Address - Street 1:2611 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3725
Practice Address - Country:US
Practice Address - Phone:352-726-0554
Practice Address - Fax:352-728-3885
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350043240OtherMEDICARE R.R.
FL593483676OtherTAX-ID
FLU51777OtherUPIN
FL225845OtherCHIRO ALLIANCE CORP.
FL225845OtherHEALTHEASE
FL380499200Medicaid
FL5503335OtherGHI
FL55185OtherBLUE CROSS/BLUE SHIELD
FL5503335OtherGHI