=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003642539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VANWINKLE FAMILY CHIROPRACTIC PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2024
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2963 W DICKMAN RD
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49037-7939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-986-8903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10507 S MACKINAC TRL
-----------------------------------------------------
City | DAFTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49724-9550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-986-8903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JENNIFER VANWINKLE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 269-986-8903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------