Healthcare Provider Details

I. General information

NPI: 1194643908
Provider Name (Legal Business Name): KACE WINTERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 N KEENE RD APT C
CLEARWATER FL
33755-5621
US

IV. Provider business mailing address

831 N KEENE RD APT C
CLEARWATER FL
33755-5621
US

V. Phone/Fax

Practice location:
  • Phone: 717-422-8497
  • Fax:
Mailing address:
  • Phone: 717-422-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: