Healthcare Provider Details

I. General information

NPI: 1396744785
Provider Name (Legal Business Name): WOODSTOCK CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712B N MAIN ST
WOODSTOCK VA
22664-1816
US

IV. Provider business mailing address

PO BOX 501
WOODSTOCK VA
22664-0501
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-4727
  • Fax: 540-459-7989
Mailing address:
  • Phone: 540-459-4727
  • Fax: 540-459-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000163
License Number StateVA

VIII. Authorized Official

Name: DR. WILLIAM G MACDONALD
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 540-459-4727