Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1803 | OR |
N | 111N00000X | Chiropractor | 3579 | WA |
NPI | 1003960675 |
---|---|
Provider Name | Dr. Dan G. Winslow |
First Address | West Linn, OR 97068-9234 |
Second Address | Clackamas, OR 97015-7612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |