Provider Demographics
NPI:1164080594
Name:WOODBURY, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:WOODBURY
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 1:6109 S NC 55 HWY STE 109
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7920
Mailing Address - Country:US
Mailing Address - Phone:919-377-9805
Mailing Address - Fax:
Practice Address - Street 1:7116 SIX FORKS RD STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6262
Practice Address - Country:US
Practice Address - Phone:919-847-3122
Practice Address - Fax:919-847-3148
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor