Provider Demographics
NPI:1174743215
Name:WINTERS, KEVIN A (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:WINTERS
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 1:8906 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9301
Mailing Address - Country:US
Mailing Address - Phone:509-548-6679
Mailing Address - Fax:
Practice Address - Street 1:1133 US HIGHWAY 2
Practice Address - Street 2:STE G
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1439
Practice Address - Country:US
Practice Address - Phone:509-548-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1715521OtherEIN
WA91-1715521OtherEIN
WA115000837Medicare ID - Type Unspecified