Provider Demographics
NPI:1649395948
Name:WHEATLEY, DONALD WOODIN (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WOODIN
Last Name:WHEATLEY
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 1:18120 SW LOWER BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7216
Mailing Address - Country:US
Mailing Address - Phone:503-968-4547
Mailing Address - Fax:503-639-7688
Practice Address - Street 1:18120 SW LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7216
Practice Address - Country:US
Practice Address - Phone:503-968-4547
Practice Address - Fax:503-639-7688
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor