Provider Demographics
NPI:1992887319
Name:WINTON, BRIAN LOWELL (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LOWELL
Last Name:WINTON
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 1:1007 MEHL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5529
Mailing Address - Country:US
Mailing Address - Phone:573-819-5075
Mailing Address - Fax:636-583-7707
Practice Address - Street 1:405 US HIGHWAY 50 W
Practice Address - Street 2:SUITE 200
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1969
Practice Address - Country:US
Practice Address - Phone:636-583-2192
Practice Address - Fax:636-583-7707
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25373Medicare UPIN