Provider Demographics
NPI:1437225711
Name:WOODS, THEODOSIA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODOSIA
Middle Name:ANN
Last Name:WOODS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ISOBEL
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1289 PACIFIC WAY
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-4360
Mailing Address - Country:US
Mailing Address - Phone:503-738-9796
Mailing Address - Fax:503-738-7018
Practice Address - Street 1:1289 PACIFIC WAY
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-4360
Practice Address - Country:US
Practice Address - Phone:503-738-9796
Practice Address - Fax:503-738-7018
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU77273Medicare UPIN