Etheredge Chiropractic PA

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

Legal business name

ETHEREDGE CHIROPRACTIC PA

Practice address

3261 US Hwy 27/441
Fruitland Park, FL 34731

Phone

(352) 365-1191

Fax

(352) 365-0330

NPI assigned

Oct 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Kim Etheredge, DCNPI 1780795294

Title

Owner/Chirpractor

Phone

(352) 365-1191

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: kim@ectv0001.direct.chirotouch.md

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Kim Etheredge, DC

  • Chiropractor
  • Fruitland Park, FL
  • NPI 1780795294
  Medicare reassignment Care Compare group NPD Authorized official
• Anthony Michael Fahsholtz, DC

  • Chiropractor
  • The Villages, FL
  • NPI 1063066223
  Medicare reassignment Care Compare group NPD
• Michael Paul Bruce, D.O

  • Chiropractor
  • Ocala, FL
  • NPI 1881635951
  NPD (past)
• Michael Joseph Paulk, D.C.

  • Chiropractor
  • Orange Park, FL
  • NPI 1285774620
  NPD (past)
• Loren Douglas Thornton, D.C.

  • Chiropractor
  • Jacksonville, FL
  • NPI 1881767341
  NPD (past)
• Robert Rich Mariner, DC

  • Chiropractor
  • Frankfort, KY
  • NPI 1063588994
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187654400000",
    "number": "1003905084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3261 US HWY 27/441",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "34731",
            "telephone_number": "352-365-1191",
            "fax_number": "352-365-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3261 US HWY 27/441",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "34731",
            "telephone_number": "352-365-1191",
            "fax_number": "352-365-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEREDGE CHIROPRACTIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-08-21",
        "status": "A",
        "authorized_official_last_name": "ETHEREDGE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "OWNER/CHIRPRACTOR",
        "authorized_official_telephone_number": "352-365-1191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelley June Deturo, M.ED.
• Divinely Chosen Services
• Easterseals Florida, Inc.
• Easterseals Florida, Inc.
• Envision Care LLC
• Richard Kim Etheredge, DC
• Kimberly Exe
• Rebecah Lynn Farish
• Liza Marie Feliciano, D.M.D.
• Amanda Suzanne Ferragamo, RD

• Orthopedic Chiropractor in Fruitland Park, FL
• Providers in Fruitland Park, FL by specialty
• Orthopedic Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.