MEDICARE: DR. MATTHEW ALAN WOODWORTH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3934	OH

General Provider Information

NPI Number	:	1043467996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW ALAN WOODWORTH D.C.

Provider Business Mailing Address
First Line	:	4365 LIBERTY AVE
Second Line	:
City	:	VERMILION
State	:	OH
Zip	:	44089-2133
Country	:	US
Telephone Number	:	440-967-4226
Fax Number	:	440-967-0296

Provider Business Practice Location Address
First Line	:	4370 RIDGE RD
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-2717
Country	:	US
Telephone Number	:	216-398-4246
Fax Number	:	216-398-7241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	03/23/2009

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