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General NPI Number Information
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NPI Number | 1841561537
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Entity Type | Organization
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Legal Business Name | WINTERS FAMILY CHIROPRACTIC, PA
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 4170 THIELMAN LN STE 104
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City | SAINT CLOUD
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State | MN
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Zip | 56301-3896
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Country | US
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Telephone | 320-202-0284
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Fax |
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Provider Business Mailing Address
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Address Line | 4170 THIELMAN LN STE 104
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City | SAINT CLOUD
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State | MN
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Zip | 56301-3896
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK WINTERS
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Credential | DC
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Telephone | 320-202-0284
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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 | 5270
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License Number State | MN
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