Provider Demographics
NPI:1609094424
Name:WODA, JAMES JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:WODA
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 1:1039 WASHINGTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2016
Mailing Address - Country:US
Mailing Address - Phone:313-724-8925
Mailing Address - Fax:313-724-8926
Practice Address - Street 1:1039 WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2016
Practice Address - Country:US
Practice Address - Phone:313-724-8925
Practice Address - Fax:313-724-8926
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H25371OtherBLUE CROSS
MI3489405Medicaid
MI0M95040Medicare UPIN