Provider Demographics
NPI:1164569414
Name:WOOTEN, JAMES RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAY
Last Name:WOOTEN
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:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0757
Mailing Address - Country:US
Mailing Address - Phone:817-220-9100
Mailing Address - Fax:817-220-9109
Practice Address - Street 1:924 E HIGHWAY 199
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-6038
Practice Address - Country:US
Practice Address - Phone:817-220-9100
Practice Address - Fax:817-220-9109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX DC 9830OtherDC LICENSE NUMBER
611500Medicare ID - Type Unspecified
VO3925Medicare UPIN