MEDICARE: JONATHAN DONALD WOOLSTON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301007764	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OC35079	OTHER		BCBS

General Provider Information

NPI Number	:	1144202698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DONALD WOOLSTON DC

Provider Business Mailing Address
First Line	:	801 N CEDAR RD
Second Line	:	ROUTE #7
City	:	MASON
State	:	MI
Zip	:	48854-9572
Country	:	US
Telephone Number	:	517-676-3117
Fax Number	:	517-676-0704

Provider Business Practice Location Address
First Line	:	801 N CEDAR RD
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-9572
Country	:	US
Telephone Number	:	517-676-3117
Fax Number	:	517-676-0704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	03/02/2015

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