Provider Demographics
NPI:1487873063
Name:WINNINGHAM, BRIAN (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WINNINGHAM
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 1:2601 GALLERIA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6749
Mailing Address - Country:US
Mailing Address - Phone:817-640-8040
Mailing Address - Fax:817-640-8067
Practice Address - Street 1:2601 GALLERIA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6749
Practice Address - Country:US
Practice Address - Phone:817-640-8040
Practice Address - Fax:817-640-8067
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8197111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation