Provider Demographics
NPI:1851465017
Name:WINK, CRAIG S (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:WINK
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 1:924 FOREST AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935
Mailing Address - Country:US
Mailing Address - Phone:920-921-4130
Mailing Address - Fax:920-921-4331
Practice Address - Street 1:924 FOREST AVE
Practice Address - Street 2:STE 101
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935
Practice Address - Country:US
Practice Address - Phone:920-921-4130
Practice Address - Fax:920-921-4331
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1628012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38766000Medicaid
WI38766000Medicaid