Provider Demographics
NPI:1609237213
Name:WOOLDRIDGE, JACQUELINE HERNANDEZ (DC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:HERNANDEZ
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:102 S MEYER ST
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5686
Mailing Address - Country:US
Mailing Address - Phone:512-268-2273
Mailing Address - Fax:800-807-8174
Practice Address - Street 1:102 S MEYER ST
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-5686
Practice Address - Country:US
Practice Address - Phone:512-268-2273
Practice Address - Fax:800-807-8174
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor