Provider Demographics
NPI:1811909385
Name:WINKLES, BILLY MIKE (DC)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:MIKE
Last Name:WINKLES
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:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-0887
Mailing Address - Country:US
Mailing Address - Phone:979-532-0261
Mailing Address - Fax:979-532-2886
Practice Address - Street 1:806 N FULTON ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3946
Practice Address - Country:US
Practice Address - Phone:979-532-0261
Practice Address - Fax:979-532-2886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI#0010910-01Medicaid
TX350002235OtherRAILROAD MEDICARE
TX89840XOtherBLUE CROSS/BLUE SHIELD
TX4203977OtherAETNA
TXT16696Medicare UPIN
TXTPI#0010910-01Medicaid