Provider Demographics
NPI:1366589152
Name:WOOLSEY, DEREK ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ALAN
Last Name:WOOLSEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ANDREW AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2166
Mailing Address - Country:US
Mailing Address - Phone:618-498-6200
Mailing Address - Fax:618-498-1607
Practice Address - Street 1:104 N STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-1701
Practice Address - Country:US
Practice Address - Phone:618-498-3447
Practice Address - Fax:618-498-1607
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor