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General NPI Number Information
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NPI Number | 1164080594
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Entity Type | Individual
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Provider Name | MICHAEL WOODBURY DC
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Gender | Male
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 7116 SIX FORKS RD STE A
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City | RALEIGH
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State | NC
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Zip | 27615-6262
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Country | US
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Telephone | 919-847-3122
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Fax | 919-847-3148
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Provider Business Mailing Address
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Address Line | 6109 S NC 55 HWY STE 109
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-7920
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Country | US
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Telephone | 919-377-9805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5083
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License Number State | NC
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