Provider Demographics
NPI:1316962939
Name:INCLEDON, JAMES DAREN (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAREN
Last Name:INCLEDON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:6609 WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-0910
Mailing Address - Country:US
Mailing Address - Phone:561-865-8390
Mailing Address - Fax:561-865-1730
Practice Address - Street 1:6609 WOOLBRIGHT RD
Practice Address - Street 2:SUITE 414
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-0910
Practice Address - Country:US
Practice Address - Phone:561-865-8390
Practice Address - Fax:561-865-1730
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH7416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14-1778307OtherRAILROAD MEDICARE
FL3818900.00Medicaid
FL53941OtherBLUE CROSS BLUE SHIELD
FLP2586587OtherOXFORD
FL604421OtherUNITED HEALTHCARE
FLP2586587OtherOXFORD
FL14-1778307OtherRAILROAD MEDICARE