Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2002 | MN |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4065 | OR |
NPI | 1740585074 |
---|---|
Provider Name | Dr. John Marshall Winckler |
First Address | Corvallis, OR 97330-3476 |
Second Address | Corvallis, OR 97330-1408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2011 |
Last Update Date | 21/06/2011 |