Provider Demographics
NPI:1043223670
Name:WINGER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WINGER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:WINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-742-2716
Mailing Address - Street 1:511 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1235
Mailing Address - Country:US
Mailing Address - Phone:765-742-2716
Mailing Address - Fax:765-807-0005
Practice Address - Street 1:511 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1235
Practice Address - Country:US
Practice Address - Phone:765-742-2716
Practice Address - Fax:765-807-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000400A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN496519OtherBCBS
IN251380Medicare PIN