Provider Demographics
NPI:1124199633
Name:WINK, THERESA E (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:E
Last Name:WINK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 MARKET ST STE 6
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5642
Mailing Address - Country:US
Mailing Address - Phone:805-650-0495
Mailing Address - Fax:805-650-0434
Practice Address - Street 1:4125 MARKET ST STE 6
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5642
Practice Address - Country:US
Practice Address - Phone:805-650-0495
Practice Address - Fax:805-650-0434
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV05266Medicare UPIN