Healthcare Provider Details

I. General information

NPI: 1396758991
Provider Name (Legal Business Name): WOODRUFF FAMILY CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4556 SALLING AVE
LEWISTON MI
49756
US

IV. Provider business mailing address

PO BOX 28 4556 SALLING AVE
LEWISTON MI
49756
US

V. Phone/Fax

Practice location:
  • Phone: 989-786-5288
  • Fax: 989-786-7349
Mailing address:
  • Phone: 989-786-5288
  • Fax: 989-786-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007872
License Number StateMI

VIII. Authorized Official

Name: DANIEL RAND WOODRUFF
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 989-786-5288