Provider Demographics
NPI:1790374130
Name:WINTERS, CASEY LYNN (DC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:WINTERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 FOXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8735
Mailing Address - Country:US
Mailing Address - Phone:218-556-9395
Mailing Address - Fax:
Practice Address - Street 1:162 US ROUTE 1 STE 4B
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8975
Practice Address - Country:US
Practice Address - Phone:207-303-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor