Provider Demographics
NPI:1043422967
Name:FAMILY CHIROPRACTIC OF PLYMOUTH, INC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OF PLYMOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WOODAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-980-3547
Mailing Address - Street 1:W 5134 HWY CTY O
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073
Mailing Address - Country:US
Mailing Address - Phone:920-980-3547
Mailing Address - Fax:866-248-9019
Practice Address - Street 1:W 5134 HWY CTY O
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073
Practice Address - Country:US
Practice Address - Phone:920-980-3547
Practice Address - Fax:866-248-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38904900Medicaid