Provider Demographics
NPI:1306120258
Name:VANWINKLE, SHAWN ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ALAN
Last Name:VANWINKLE
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 1:4305 S PLEASANT CROSSING BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1495
Mailing Address - Country:US
Mailing Address - Phone:479-340-0977
Mailing Address - Fax:479-340-0976
Practice Address - Street 1:4305 S PLEASANT CROSSING BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1495
Practice Address - Country:US
Practice Address - Phone:479-340-0977
Practice Address - Fax:479-340-0976
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2023-01-09
Deactivation Date:2018-03-19
Deactivation Code:
Reactivation Date:2022-10-26
Provider Licenses
StateLicense IDTaxonomies
AR16371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor