Provider Demographics
NPI:1154502680
Name:WOOSLEY, CHARLTON A (DC)
Entity Type:Individual
Prefix:
First Name:CHARLTON
Middle Name:A
Last Name:WOOSLEY
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 1:913 CONFERENCE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1991
Mailing Address - Country:US
Mailing Address - Phone:615-859-6644
Mailing Address - Fax:615-859-5577
Practice Address - Street 1:913 CONFERENCE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1991
Practice Address - Country:US
Practice Address - Phone:615-859-6644
Practice Address - Fax:615-859-5577
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715635OtherGROUP
TN3673903Medicare PIN