Provider Demographics
NPI:1790883460
Name:VANWINKLE, CARRIE L (DC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:VANWINKLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:STRYCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:132 N EMERY AVE
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1214
Mailing Address - Country:US
Mailing Address - Phone:715-582-4098
Mailing Address - Fax:715-582-4097
Practice Address - Street 1:132 N EMERY AVE
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1214
Practice Address - Country:US
Practice Address - Phone:715-582-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3893-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WICB3715OtherRAILROAD MEDICARE GROUP
MI145186845Medicaid
WI38945300Medicaid
WI350057077OtherRAILROAD MEDICARE
WI38998100OtherMEDICAID GROUP
MI145186845Medicaid
WI350057077OtherRAILROAD MEDICARE