Healthcare Provider Details

I. General information

NPI: 1528050952
Provider Name (Legal Business Name): GLENN M WINNESTAFFER DC, DIBCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 S HAMILTON RD SUITE B
GAHANNA OH
43230-3311
US

IV. Provider business mailing address

358 S HAMILTON RD SUITE B
GAHANNA OH
43230-3311
US

V. Phone/Fax

Practice location:
  • Phone: 614-471-5442
  • Fax: 614-471-5462
Mailing address:
  • Phone: 614-471-5442
  • Fax: 614-471-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: