Provider Demographics
NPI:1548766827
Name:WOODBURN, MARCUS KEITH
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:KEITH
Last Name:WOODBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 AIRPORT RD STE C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5701
Mailing Address - Country:US
Mailing Address - Phone:334-321-7275
Mailing Address - Fax:888-505-3765
Practice Address - Street 1:2013 OLDE REGENT WAY STE 170
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4194
Practice Address - Country:US
Practice Address - Phone:910-477-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor