Provider Demographics
NPI:1912909680
Name:WOODWARD, WILLIAM RANDALL (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDALL
Last Name:WOODWARD
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:PO BOX 6127
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-6127
Mailing Address - Country:US
Mailing Address - Phone:936-295-5777
Mailing Address - Fax:936-295-4810
Practice Address - Street 1:2507 LAKE RD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5735
Practice Address - Country:US
Practice Address - Phone:936-295-5777
Practice Address - Fax:936-295-4810
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-10-24
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TX6624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605678Medicare ID - Type Unspecified