Provider Demographics
NPI:1427766476
Name:WINDECKER, KODY RYAN (DC)
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:RYAN
Last Name:WINDECKER
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 1:4855B THOMPSON PKWY
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-6517
Mailing Address - Country:US
Mailing Address - Phone:970-669-2003
Mailing Address - Fax:
Practice Address - Street 1:4855B THOMPSON PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6517
Practice Address - Country:US
Practice Address - Phone:970-669-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor