Provider Demographics
NPI:1306005327
Name:WOODSIDE, JUSTIN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:WOODSIDE
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 1:1300 S MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5662
Mailing Address - Country:US
Mailing Address - Phone:928-536-5525
Mailing Address - Fax:928-536-3010
Practice Address - Street 1:1300 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5662
Practice Address - Country:US
Practice Address - Phone:928-536-5525
Practice Address - Fax:928-484-6070
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor