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General NPI Number Information
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NPI Number | 1043422967
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC OF PLYMOUTH, INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | W 5134 HWY CTY O
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City | PLYMOUTH
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State | WI
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Zip | 53073
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Country | US
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Telephone | 920-980-3547
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Fax | 866-248-9019
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Provider Business Mailing Address
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Address Line | W 5134 HWY CTY O
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City | PLYMOUTH
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State | WI
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Zip | 53073
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Country | US
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Telephone | 920-980-3547
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Fax | 866-248-9019
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW DEAN WOODAS
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Credential | DC
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Telephone | 920-980-3547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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