Provider Demographics
NPI:1720062136
Name:WOOLARD, MICHAEL A (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:WOOLARD
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 1:1300 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1983
Mailing Address - Country:US
Mailing Address - Phone:317-745-5111
Mailing Address - Fax:317-745-2435
Practice Address - Street 1:1300 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1983
Practice Address - Country:US
Practice Address - Phone:317-745-5111
Practice Address - Fax:317-745-2435
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001667A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200085140AMedicaid
IN200085140AMedicaid