Provider Demographics
NPI:1023381324
Name:BRUCE D WOODS JR
Entity Type:Organization
Organization Name:BRUCE D WOODS JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-618-5600
Mailing Address - Street 1:4204 LAFAYETTE ST
Mailing Address - Street 2:APT 1235
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-4485
Mailing Address - Country:US
Mailing Address - Phone:214-618-5600
Mailing Address - Fax:214-618-7733
Practice Address - Street 1:4204 LAFAYETTE ST
Practice Address - Street 2:APT 1235
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-4485
Practice Address - Country:US
Practice Address - Phone:214-618-5600
Practice Address - Fax:214-618-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty