Provider Demographics
NPI:1710374483
Name:KIRKPATRICK, SEAN MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MATTHEW
Last Name:KIRKPATRICK
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 1:2642 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-5831
Mailing Address - Country:US
Mailing Address - Phone:239-334-7558
Mailing Address - Fax:239-334-7558
Practice Address - Street 1:2642 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5831
Practice Address - Country:US
Practice Address - Phone:239-334-7558
Practice Address - Fax:239-334-7558
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor