Provider Demographics
NPI:1124358387
Name:WOODRUM, VERONICA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:LYNN
Last Name:WOODRUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1020
Mailing Address - Country:US
Mailing Address - Phone:317-250-0332
Mailing Address - Fax:
Practice Address - Street 1:122 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1311
Practice Address - Country:US
Practice Address - Phone:317-485-3167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002483A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor