Provider Demographics
NPI:1033235445
Name:WINE, DOUGLAS ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:WINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 WINNACUNNET RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2121
Mailing Address - Country:US
Mailing Address - Phone:603-929-5000
Mailing Address - Fax:603-929-5008
Practice Address - Street 1:58 WINNACUNNET RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2121
Practice Address - Country:US
Practice Address - Phone:603-929-5000
Practice Address - Fax:603-929-5008
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH218-0495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU57344Medicare UPIN
NHRE3843Medicare ID - Type UnspecifiedNHIC