Provider Demographics
NPI:1972782068
Name:RICHARD J WOOLMAN DC PC
Entity type:Organization
Organization Name:RICHARD J WOOLMAN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-557-1818
Mailing Address - Street 1:24777 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3065
Mailing Address - Country:US
Mailing Address - Phone:248-557-1818
Mailing Address - Fax:248-557-3014
Practice Address - Street 1:24777 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3065
Practice Address - Country:US
Practice Address - Phone:248-557-1818
Practice Address - Fax:248-557-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRW006163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F325700OtherBLUE CROSS
MIRW006163OtherST LICENSE NO
MI017904OtherDMC HEALTH
MI4866695Medicaid
MIRW006163OtherST LICENSE NO
MI0P30580001Medicare PIN