Provider Demographics
NPI:1740585074
Name:WINCKLER, JOHN MARSHALL (DC, DACO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARSHALL
Last Name:WINCKLER
Suffix:
Gender:M
Credentials:DC, DACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 NW POPPY DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3476
Mailing Address - Country:US
Mailing Address - Phone:651-308-2366
Mailing Address - Fax:541-230-1327
Practice Address - Street 1:999 NW CIRCLE BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1408
Practice Address - Country:US
Practice Address - Phone:541-754-2225
Practice Address - Fax:541-752-9086
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4065111NX0800X
MN2002111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic