Provider Demographics
NPI:1366440745
Name:WINSTON, JEFFREY DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DANIEL
Last Name:WINSTON
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 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-1823
Practice Address - Street 1:7503B ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1701
Practice Address - Country:US
Practice Address - Phone:240-296-1112
Practice Address - Fax:240-296-1097
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010438-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1647Medicare ID - Type UnspecifiedMEDICARE