Provider Demographics
NPI:1518970391
Name:WINGER, LORI MARTHA (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:MARTHA
Last Name:WINGER
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 1:511 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001986A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN496519OtherBCBS
IN200335670AMedicaid
IN496519OtherBCBS
IN200335670AMedicaid