Provider Demographics
NPI:1720026545
Name:WINKLEBLECH, KEITH C (DC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:C
Last Name:WINKLEBLECH
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 1:893 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-1369
Mailing Address - Country:US
Mailing Address - Phone:724-223-0590
Mailing Address - Fax:
Practice Address - Street 1:893 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-1369
Practice Address - Country:US
Practice Address - Phone:724-223-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005316L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028393Medicare UPIN