Healthcare Provider Details

I. General information

NPI: 1245456391
Provider Name (Legal Business Name): PAUL R WINTERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PORTLAND STREET SUITE C
MORRISVILLE VT
05661
US

IV. Provider business mailing address

PO BOX 1566
MORRISVILLE VT
05661
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-1060
  • Fax: 802-888-1750
Mailing address:
  • Phone: 802-888-1060
  • Fax: 802-888-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number006-0001127
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: