MEDICARE: WINK CHIROPRACTIC & REHABILITATION CENTER, INC.

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	:	1780987651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINK CHIROPRACTIC & REHABILITATION CENTER, INC.

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	:	OWNER
Name	:	DR. KEITH WINKLEBLECH
Credential	:	D.C.
Telephone Number	:	724-223-0590

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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