Provider Demographics
NPI:1942354634
Name:MICHAEL A. WINTERS DC PSC
Entity Type:Organization
Organization Name:MICHAEL A. WINTERS DC PSC
Other - Org Name:WINTERS CHIROPRACTIC OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-554-2141
Mailing Address - Street 1:2830 LONE OAK RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8044
Mailing Address - Country:US
Mailing Address - Phone:270-554-2141
Mailing Address - Fax:270-554-8795
Practice Address - Street 1:2830 LONE OAK RD
Practice Address - Street 2:SUITE #4
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8044
Practice Address - Country:US
Practice Address - Phone:270-554-2141
Practice Address - Fax:270-554-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002434Medicaid
KY85002434Medicaid
00649001Medicare PIN