Provider Demographics
NPI:1689859282
Name:WOOLVERTON CHIROPRACTIC DC PC
Entity Type:Organization
Organization Name:WOOLVERTON CHIROPRACTIC DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARD
Authorized Official - Middle Name:BENTLEY
Authorized Official - Last Name:WOOLVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-231-4231
Mailing Address - Street 1:2093 N COLLINS BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-8302
Mailing Address - Country:US
Mailing Address - Phone:972-231-4231
Mailing Address - Fax:972-907-8900
Practice Address - Street 1:2093 N COLLINS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-8302
Practice Address - Country:US
Practice Address - Phone:972-231-4231
Practice Address - Fax:972-907-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T33UOtherBLUE CROSS BLUE SHIELD
TX00T33UMedicare PIN