MEDICARE: DR. ROBERT P WOODWARD JR. 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	3685	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	350046348	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000181090	OTHER	KY	BC/BS

General Provider Information

NPI Number	:	1265416762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT P WOODWARD JR. D.C.

Provider Business Mailing Address
First Line	:	4008 PRESTON HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1612
Country	:	US
Telephone Number	:	502-366-1413
Fax Number	:	502-366-1414

Provider Business Practice Location Address
First Line	:	4008 PRESTON HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40213-1612
Country	:	US
Telephone Number	:	502-366-1413
Fax Number	:	502-366-1414

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/19/2014

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