Provider Demographics
NPI:1518444645
Name:WOODLEY, DYNISHA ANTIONETTE (DC)
Entity Type:Individual
Prefix:MS
First Name:DYNISHA
Middle Name:ANTIONETTE
Last Name:WOODLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13083 HIGHWAY 9 N STE 710
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5153
Mailing Address - Country:US
Mailing Address - Phone:770-559-7413
Mailing Address - Fax:
Practice Address - Street 1:13083 HIGHWAY 9 N STE 710
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-5153
Practice Address - Country:US
Practice Address - Phone:770-559-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor