Provider Demographics
NPI:1902954043
Name:WINIGER, TY WALLACE (DC)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:WALLACE
Last Name:WINIGER
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 1:721 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-5423
Mailing Address - Country:US
Mailing Address - Phone:812-424-8514
Mailing Address - Fax:
Practice Address - Street 1:721 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-5423
Practice Address - Country:US
Practice Address - Phone:812-424-8514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002012A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU93912Medicare UPIN
IN200410BMedicare PIN