Provider Demographics
NPI:1699477570
Name:WOODBURY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:WOODBURY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-880-8911
Mailing Address - Street 1:13461 PARKER COMMONS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1839
Mailing Address - Country:US
Mailing Address - Phone:701-880-8911
Mailing Address - Fax:
Practice Address - Street 1:13461 PARKER COMMONS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1839
Practice Address - Country:US
Practice Address - Phone:701-880-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty