Provider Demographics
NPI:1568463693
Name:WINTERS, MICHAEL ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:WINTERS
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 1:2830 LONE OAK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8044
Mailing Address - Country:US
Mailing Address - Phone:270-554-2141
Mailing Address - Fax:270-554-8795
Practice Address - Street 1:2830 LONE OAK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8044
Practice Address - Country:US
Practice Address - Phone:270-554-2141
Practice Address - Fax:270-554-8795
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY261469OtherHEALTHLINK PIN#
KY85002434Medicaid
KY000000062836OtherANTHEM BC & BS
KY350048628OtherRAILROAD MEDICARE
KY261469OtherHEALTHLINK PIN#
KY6042801Medicare PIN