Provider Demographics
NPI:1487829552
Name:JON WOOLSTON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:JON WOOLSTON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-676-3117
Mailing Address - Street 1:801 N CEDAR RD RT 7
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9572
Mailing Address - Country:US
Mailing Address - Phone:517-676-3117
Mailing Address - Fax:517-676-0704
Practice Address - Street 1:801 N CEDAR RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9572
Practice Address - Country:US
Practice Address - Phone:517-676-3117
Practice Address - Fax:517-676-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI950C350790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU73689Medicare UPIN
MI0M75960Medicare PIN