MEDICARE: DR. MATTHEW MARK WOOLLEY 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	5368537-1202	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87039551	OTHER	UT	CHIROPRACTIC HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245373224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW MARK WOOLLEY D.C.

Provider Business Mailing Address
First Line	:	2061 E 9400 S
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-3128
Country	:	US
Telephone Number	:	801-943-8308
Fax Number	:	801-438-0058

Provider Business Practice Location Address
First Line	:	2061 E 9400 S
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-3128
Country	:	US
Telephone Number	:	801-943-8308
Fax Number	:	801-438-0058

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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