Provider Demographics
NPI:1972629335
Name:WOUDSMA CHIROPRACTIC ASSOC. INC.
Entity type:Organization
Organization Name:WOUDSMA CHIROPRACTIC ASSOC. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOUDSMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-269-4873
Mailing Address - Street 1:606 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1802
Mailing Address - Country:US
Mailing Address - Phone:215-836-8888
Mailing Address - Fax:215-836-1588
Practice Address - Street 1:606 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1802
Practice Address - Country:US
Practice Address - Phone:215-836-8888
Practice Address - Fax:215-836-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008025L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW001586226OtherHIGHMARK BLUE SHIELD PROV
PW2269666000OtherHMO ID #