MEDICARE: DR. STEPHEN WOOTEN 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	CH7753	FL
2	111N00000X	Chiropractor	038-008647	IL

General Provider Information

NPI Number	:	1346333242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN WOOTEN DC

Provider Business Mailing Address
First Line	:	1400 HANCOCK BLVD APT 716
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 S CLYDE MORRIS BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4103
Country	:	US
Telephone Number	:	386-763-2718
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/29/2011

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Directions to “ DR. STEPHEN WOOTEN DC” Practice Location

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