Provider Demographics
NPI:1043467996
Name:WOODWORTH, MATTHEW ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALAN
Last Name:WOODWORTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-2133
Mailing Address - Country:US
Mailing Address - Phone:440-967-4226
Mailing Address - Fax:440-967-0296
Practice Address - Street 1:4370 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2717
Practice Address - Country:US
Practice Address - Phone:216-398-4246
Practice Address - Fax:216-398-7241
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor