Healthcare Provider Details

I. General information

NPI: 1194537670
Provider Name (Legal Business Name): TIMOTHY R WOODEAN CHIROPRACTIC AND MASSAGE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 LAKE ST STE 3
WILSON NY
14172-9600
US

IV. Provider business mailing address

4233 CAMBRIA WILSON RD
LOCKPORT NY
14094-9797
US

V. Phone/Fax

Practice location:
  • Phone: 716-751-2222
  • Fax:
Mailing address:
  • Phone: 716-243-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY ROBERT WOODEAN
Title or Position: CHIROPRACTOR/OWNER
Credential: DC LMT
Phone: 716-751-2222