Provider Demographics
NPI:1972904019
Name:VANWINKLE FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:VANWINKLE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VANWINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-582-4098
Mailing Address - Street 1:880 FRONTAGE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1725
Mailing Address - Country:US
Mailing Address - Phone:715-582-4098
Mailing Address - Fax:715-582-4097
Practice Address - Street 1:880 FRONTAGE RD
Practice Address - Street 2:SUITE H
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1725
Practice Address - Country:US
Practice Address - Phone:715-582-4098
Practice Address - Fax:715-582-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3893-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1790883460OtherNPI
WIU94330Medicare UPIN