MEDICARE: DR. CHANG W WOO D.C

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	X010435	NY

General Provider Information

NPI Number	:	1225197080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANG W WOO D.C

Provider Business Mailing Address
First Line	:	8908 ROOSEVELT AVE
Second Line	:	2ND FLOOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7857
Country	:	US
Telephone Number	:	718-424-1454
Fax Number	:	718-424-1412

Provider Business Practice Location Address
First Line	:	8908 ROOSEVELT AVE
Second Line	:	2ND FLOOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7857
Country	:	US
Telephone Number	:	718-424-1454
Fax Number	:	718-424-1412

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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