Provider Demographics
NPI:1528081262
Name:VANWINKLE, JENNIFER LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:VANWINKLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10507 S MACKINAC TRL
Mailing Address - Street 2:
Mailing Address - City:DAFTER
Mailing Address - State:MI
Mailing Address - Zip Code:49724-9550
Mailing Address - Country:US
Mailing Address - Phone:269-986-8903
Mailing Address - Fax:
Practice Address - Street 1:2963 W DICKMAN RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-7939
Practice Address - Country:US
Practice Address - Phone:269-223-7870
Practice Address - Fax:269-223-7871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJV007322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI63011Medicare UPIN
MI0N65850Medicare ID - Type Unspecified
MI350057051Medicare ID - Type UnspecifiedRAILROAD MEDICARE