Provider Demographics
NPI:1124379508
Name:WOOLNER ENTERPRISES PC
Entity Type:Organization
Organization Name:WOOLNER ENTERPRISES PC
Other - Org Name:ALIGN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOOLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-639-1397
Mailing Address - Street 1:750 W USTICK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6133
Mailing Address - Country:US
Mailing Address - Phone:208-639-1397
Mailing Address - Fax:208-287-3656
Practice Address - Street 1:750 W USTICK RD STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6133
Practice Address - Country:US
Practice Address - Phone:208-639-1397
Practice Address - Fax:208-287-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty