=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194537670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIMOTHY R WOODEAN CHIROPRACTIC AND MASSAGE THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2025
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 638 LAKE ST STE 3
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14172-9600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-751-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4233 CAMBRIA WILSON RD
-----------------------------------------------------
City | LOCKPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14094-9797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-243-5136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/OWNER
-----------------------------------------------------
Name | TIMOTHY ROBERT WOODEAN
-----------------------------------------------------
Credential | DC LMT
-----------------------------------------------------
Telephone | 716-751-2222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------