MEDICARE: KEITH C WINKLEBLECH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC005316L	PA

General Provider Information

NPI Number	:	1720026545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH C WINKLEBLECH DC

Provider Business Mailing Address
First Line	:	893 HENDERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-1369
Country	:	US
Telephone Number	:	724-223-0590
Fax Number	:

Provider Business Practice Location Address
First Line	:	893 HENDERSON AVE
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-1369
Country	:	US
Telephone Number	:	724-223-0590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/14/2010

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