Provider Demographics
NPI:1619414398
Name:WOOLSTENHULME, SETH TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:TYLER
Last Name:WOOLSTENHULME
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 1:859 WASHINGTON BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4972
Mailing Address - Country:US
Mailing Address - Phone:801-621-6155
Mailing Address - Fax:801-621-6158
Practice Address - Street 1:859 WASHINGTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4972
Practice Address - Country:US
Practice Address - Phone:801-621-6155
Practice Address - Fax:801-621-6158
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10208350-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor