Provider Demographics
NPI:1992710644
Name:WINCHIP, LAURA L (DC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:WINCHIP
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 1:525 EAST 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1602
Mailing Address - Country:US
Mailing Address - Phone:563-386-4434
Mailing Address - Fax:563-386-5306
Practice Address - Street 1:525 EAST 38TH STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1602
Practice Address - Country:US
Practice Address - Phone:563-386-4434
Practice Address - Fax:563-386-5306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0078998Medicaid
IAG46301OtherJOHN DEERE
IAU25556Medicare UPIN
IA06404Medicare ID - Type Unspecified