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General NPI Number Information
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NPI Number | 1831374719
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Entity Type | Organization
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Legal Business Name | DR GARY R WINEBRENNER, PC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 406 SE 131ST AVE SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98683-4004
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Country | US
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Telephone | 360-213-0021
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Fax | 360-213-1269
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Provider Business Mailing Address
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Address Line | 406 SE 131ST AVE SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98683-4004
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Country | US
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Telephone | 360-213-0021
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Fax | 360-213-1269
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY ROBERT WINEBRENNER
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Credential | D.C.
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Telephone | 360-213-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | CH00034321
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License Number State | WA
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