Provider Demographics
NPI:1740388115
Name:WOODAS, ANDREW D (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:WOODAS
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 1:275 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-3315
Mailing Address - Country:US
Mailing Address - Phone:920-467-8690
Mailing Address - Fax:920-467-0373
Practice Address - Street 1:126 E MILL ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-1704
Practice Address - Country:US
Practice Address - Phone:920-892-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3483-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075195Medicare ID - Type UnspecifiedMEDICARE