=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043248685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOOSLEY CHIROPRACTIC REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 02/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 913 CONFERENCE DR #104
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072-1991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-859-6644
-----------------------------------------------------
Fax | 615-859-5577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 CONFERENCE DR #104
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-859-6644
-----------------------------------------------------
Fax | 615-859-5577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. CHARLTON A WOOSLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-859-6644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC539
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------