Provider Demographics
NPI:1578532354
Name:WOELTJEN, DONALD HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HENRY
Last Name:WOELTJEN
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 1:5800 COLONIAL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5674
Mailing Address - Country:US
Mailing Address - Phone:954-815-1522
Mailing Address - Fax:954-968-8468
Practice Address - Street 1:5800 COLONIAL DR STE 305
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-815-1522
Practice Address - Fax:954-968-8468
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDX689AOtherMEDICARE PTAN GROUP
FL015879400Medicaid
FL89553YOtherMEDICARE PTAN INDIVIDUAL