Provider Demographics
NPI:1699771097
Name:WOODS, THOMAS A (DC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:WOODS
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 1:106 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3214
Mailing Address - Country:US
Mailing Address - Phone:502-893-0757
Mailing Address - Fax:502-893-0794
Practice Address - Street 1:106 BROWNS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3214
Practice Address - Country:US
Practice Address - Phone:502-893-0757
Practice Address - Fax:502-893-0794
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051383OtherANTHEM
KYT78563Medicare UPIN
KY6046301Medicare ID - Type Unspecified