Provider Demographics
NPI:1750409298
Name:WINER, MICHAEL D (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:WINER
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 1:1504 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3731
Mailing Address - Country:US
Mailing Address - Phone:503-233-1304
Mailing Address - Fax:
Practice Address - Street 1:1523 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1446
Practice Address - Country:US
Practice Address - Phone:503-233-1304
Practice Address - Fax:503-595-0234
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-2572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor