Provider Demographics
NPI:1699867697
Name:WOODARD, SHAWN KURT (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:KURT
Last Name:WOODARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:485 WILDWOOD PKWY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2667
Mailing Address - Country:US
Mailing Address - Phone:636-391-1800
Mailing Address - Fax:636-391-1800
Practice Address - Street 1:485 WILDWOOD PKWY
Practice Address - Street 2:SUITE #1
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2667
Practice Address - Country:US
Practice Address - Phone:636-391-1800
Practice Address - Fax:636-391-1800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor