Healthcare Provider Details

I. General information

NPI: 1295804268
Provider Name (Legal Business Name): CYNTHIA WINSTON CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W ROOSEVELT RD
BROADVIEW IL
60155-3888
US

IV. Provider business mailing address

2200 W ROOSEVELT RD
BROADVIEW IL
60155-3888
US

V. Phone/Fax

Practice location:
  • Phone: 708-345-0223
  • Fax: 708-345-0269
Mailing address:
  • Phone: 708-345-0223
  • Fax: 708-345-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007423
License Number StateIL

VIII. Authorized Official

Name: DR. CYNTHIA DENISE WINSTON
Title or Position: OWNER
Credential: DC
Phone: 708-345-0223