Provider Demographics
NPI:1144202698
Name:WOOLSTON, JONATHAN DONALD (DC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DONALD
Last Name:WOOLSTON
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 1:801 N CEDAR RD
Mailing Address - Street 2:ROUTE #7
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9572
Mailing Address - Country:US
Mailing Address - Phone:517-676-3117
Mailing Address - Fax:517-676-0704
Practice Address - Street 1:801 N CEDAR RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9572
Practice Address - Country:US
Practice Address - Phone:517-676-3117
Practice Address - Fax:517-676-0704
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OC35079OtherBCBS
U73689Medicare UPIN
MIOM75960Medicare ID - Type Unspecified