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General NPI Number Information
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NPI Number | 1043223670
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Entity Type | Organization
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Legal Business Name | WINGER CHIROPRACTIC PC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 511 S 16TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47905-1235
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Country | US
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Telephone | 765-742-2716
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Fax | 765-807-0005
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Provider Business Mailing Address
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Address Line | 511 S 16TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47905-1235
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Country | US
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Telephone | 765-742-2716
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Fax | 765-807-0005
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Authorized Official
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Title or Position | SECRETARY OF THE CORPORATION
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Name | MR. MICHAEL SHANE WINGER
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Credential |
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Telephone | 765-742-2716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 51000400A
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License Number State | IN
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