Provider Demographics
NPI:1376543561
Name:WOYWOOD, ROGER BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:BRIAN
Last Name:WOYWOOD
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 1:12702 TOEPPERWEIN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3267
Mailing Address - Country:US
Mailing Address - Phone:210-646-9060
Mailing Address - Fax:210-646-6219
Practice Address - Street 1:12702 TOEPPERWEIN RD STE 140
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3267
Practice Address - Country:US
Practice Address - Phone:210-646-9060
Practice Address - Fax:210-646-6219
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126018406Medicaid
TX8G2984OtherBCBS
TX8A3241Medicare ID - Type Unspecified
TX8G2984OtherBCBS