MEDICARE: VAN WINKLE CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4124	KY

General Provider Information

NPI Number	:	1124348495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN WINKLE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2161 LEXINGTON RD
Second Line	:	SUITE 3
City	:	RICHMOND
State	:	KY
Zip	:	40475-7952
Country	:	US
Telephone Number	:	941-650-9453
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 LEXINGTON RD
Second Line	:	SUITE 3
City	:	RICHMOND
State	:	KY
Zip	:	40475-7952
Country	:	US
Telephone Number	:	941-650-9453
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. JAMES R VAN WINKLE
Credential	:	D.C.
Telephone Number	:	941-650-9453

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	06/09/2010

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