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General NPI Number Information
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NPI Number | 1780748608
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Entity Type | Organization
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Legal Business Name | WINK CHIROPRACTIC WELLNESS CENTER, SC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 924 FOREST AVE SUITE 101
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City | FOND DU LAC
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State | WI
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Zip | 54935-3807
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Country | US
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Telephone | 920-921-4130
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Fax | 920-921-4331
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Provider Business Mailing Address
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Address Line | 924 FOREST AVE SUITE 101
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City | FOND DU LAC
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State | WI
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Zip | 54935-3807
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Country | US
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Telephone | 920-921-4130
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Fax | 920-921-4331
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Authorized Official
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Title or Position | OWNER
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Name | DR. CRAIG S WINK
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Credential | DC
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Telephone | 920-921-4130
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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 | 3126012
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1628012
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License Number State | WI
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