Provider Demographics
NPI:1043248685
Name:WOOSLEY CHIROPRACTIC REHABILITATION
Entity Type:Organization
Organization Name:WOOSLEY CHIROPRACTIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-859-6644
Mailing Address - Street 1:913 CONFERENCE DR
Mailing Address - Street 2:#104
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072
Mailing Address - Country:US
Mailing Address - Phone:615-859-6644
Mailing Address - Fax:615-859-5577
Practice Address - Street 1:913 CONFERENCE DR
Practice Address - Street 2:#104
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1991
Practice Address - Country:US
Practice Address - Phone:615-859-6644
Practice Address - Fax:615-859-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715635Medicare PIN