Provider Demographics
NPI:1508909391
Name:WOOLLEY, HOWARD (DC)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:WOOLLEY
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 1:3930 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-1530
Mailing Address - Country:US
Mailing Address - Phone:507-452-4490
Mailing Address - Fax:507-452-4803
Practice Address - Street 1:3930 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-1530
Practice Address - Country:US
Practice Address - Phone:507-452-4490
Practice Address - Fax:507-452-4803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1379111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNE52710Medicare UPIN
MN350000527Medicare PIN