Provider Demographics
NPI:1376613273
Name:WOOSTER, ROCK A (DC)
Entity Type:Individual
Prefix:
First Name:ROCK
Middle Name:A
Last Name:WOOSTER
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 1:106 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3715
Mailing Address - Country:US
Mailing Address - Phone:501-365-3306
Mailing Address - Fax:501-365-3307
Practice Address - Street 1:106 S 7TH ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3715
Practice Address - Country:US
Practice Address - Phone:501-365-3306
Practice Address - Fax:501-365-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16073111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN08123318OtherBCBS GROUP
T43448Medicare UPIN
TN08123318OtherBCBS GROUP
TN3676607Medicare PIN