Provider Demographics
NPI:1194001537
Name:DR. WILLIAM K. WOOTEN, D.C. P.C.
Entity Type:Organization
Organization Name:DR. WILLIAM K. WOOTEN, D.C. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-429-5882
Mailing Address - Street 1:5815 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1142
Mailing Address - Country:US
Mailing Address - Phone:269-429-5882
Mailing Address - Fax:269-429-9441
Practice Address - Street 1:5815 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1142
Practice Address - Country:US
Practice Address - Phone:269-429-5882
Practice Address - Fax:269-429-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A15024Medicare UPIN