Provider Demographics
NPI:1275622474
Name:DEWINTER, MINDY C (DC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:C
Last Name:DEWINTER
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 1:1000 1ST ST E
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1827
Mailing Address - Country:US
Mailing Address - Phone:218-237-1770
Mailing Address - Fax:218-237-1771
Practice Address - Street 1:1000 1ST ST E
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1827
Practice Address - Country:US
Practice Address - Phone:218-237-1770
Practice Address - Fax:218-237-1771
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN589153100Medicaid
MN74B16PEOtherBLUE CROSS/BLUE SHIELD