Healthcare Provider Details

I. General information

NPI: 1184745978
Provider Name (Legal Business Name): WOODCOCK CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 COOLIDGE HWY
GUILFORD VT
05301-8015
US

IV. Provider business mailing address

491 COOLIDGE HWY
GUILFORD VT
05301-8015
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-8335
  • Fax: 802-257-0993
Mailing address:
  • Phone: 802-254-8335
  • Fax: 802-257-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number0060000577
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number0060000767
License Number StateVT

VIII. Authorized Official

Name: GAYLE A HIGLEY
Title or Position: OFFICE MGR
Credential:
Phone: 802-254-8335