Richard Kim Etheredge, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH5758 Issued in FL

Practice address

3261 US Highway 441/27
Fruitland Park, FL 34731-4497

Phone

(352) 365-1191

Fax

(352) 365-0330

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Etheredge Chiropractic PAGroup PAC ID 0042281172, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Etheredge Chiropractic PA

  • Orthopedic Chiropractor
  • Fruitland Park, FL
  • NPI 1003905084
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1780795294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3261 US HIGHWAY 27/441",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347314497",
            "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 HIGHWAY 441/27",
            "city": "FRUITLAND PARK",
            "state": "FL",
            "postal_code": "347314497",
            "telephone_number": "352-365-1191",
            "fax_number": "352-365-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHEREDGE",
        "first_name": "RICHARD",
        "middle_name": "KIM",
        "name_prefix": "Mr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH5758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "22261",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "380121700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Divinely Chosen Services
• Easterseals Florida, Inc.
• Easterseals Florida, Inc.
• Envision Care LLC
• Etheredge Chiropractic PA
• Kimberly Exe
• Rebecah Lynn Farish
• Liza Marie Feliciano, D.M.D.
• Amanda Suzanne Ferragamo, RD
• Fivestar Medical Supplies, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.