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General NPI Number Information
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NPI Number | 1811193022
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Entity Type | Organization
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Legal Business Name | WOOTENCHIROPRACTIC AND PREEMPLOYMENT SERVICES
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 JACKSON AVE S
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2206
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Country | US
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Telephone | 256-331-0208
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Fax | 256-331-0308
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Provider Business Mailing Address
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Address Line | 301 JACKSON AVE S
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2206
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Country | US
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Telephone | 256-331-0208
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Fax | 256-331-0308
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Authorized Official
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Title or Position | CEO
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Name | DR. RICK WOOTEN
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Credential | D.C
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Telephone | 256-331-0208
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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 | 1826
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License Number State | AL
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