Provider Demographics
NPI:1548392814
Name:WOOTEN, WILLIAM KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEITH
Last Name:WOOTEN
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 1:5815 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1142
Mailing Address - Country:US
Mailing Address - Phone:269-429-5882
Mailing Address - Fax:269-429-9441
Practice Address - Street 1:5815 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1142
Practice Address - Country:US
Practice Address - Phone:269-429-5882
Practice Address - Fax:269-429-9441
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A15024Medicare ID - Type Unspecified
MI950A15024Medicare UPIN