Provider Demographics
NPI:1831143486
Name:WINNER, LAURIE M (BSN, DC)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:M
Last Name:WINNER
Suffix:
Gender:F
Credentials:BSN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 PINE VALLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-5344
Mailing Address - Country:US
Mailing Address - Phone:910-846-3300
Mailing Address - Fax:910-846-4453
Practice Address - Street 1:1786 PINE VALLEY DR SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-5344
Practice Address - Country:US
Practice Address - Phone:910-846-3300
Practice Address - Fax:910-846-4453
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890847PMedicaid
NC0847POtherBC/BS
NC2454004Medicare PIN
NCU79568Medicare UPIN