Provider Demographics
NPI:1568661080
Name:WINCHESTER CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:WINCHESTER CHIROPRACTIC, P.C.
Other - Org Name:WINCHESTER-HILGEFORT SPINE & JOINT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGEFORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-356-5557
Mailing Address - Street 1:40 WALTER CT
Mailing Address - Street 2:
Mailing Address - City:MOSCOW MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63362-1197
Mailing Address - Country:US
Mailing Address - Phone:636-356-5557
Mailing Address - Fax:636-356-5558
Practice Address - Street 1:40 WALTER CT
Practice Address - Street 2:
Practice Address - City:MOSCOW MILLS
Practice Address - State:MO
Practice Address - Zip Code:63362-1197
Practice Address - Country:US
Practice Address - Phone:636-356-5557
Practice Address - Fax:636-356-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003011597111N00000X
MO2004010186111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO653134OtherUNITED HEALTHCARE
MO471354OtherBLUE CROSS BLUE SHIELD
MO665379OtherUNITED HEALTHCARE
MOV03758OtherMERCY
MO551715OtherHEALTHLINK
MO713979OtherHEALTHLINK
MO7171684OtherAETNA
MO7368716OtherAETNA
1255473864OtherNPI FOR DR. WINCHESTER
1326180951OtherNIP DR. HILGEFORT
MO195807OtherBLUE CROSS BLUE SHIELD
MOU96934OtherMERCY
MOU96934OtherMERCY
MO665379OtherUNITED HEALTHCARE
MO000014275Medicare PIN