Provider Demographics
NPI:1760495360
Name:WOODRUFF, DANIEL RAND (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAND
Last Name:WOODRUFF
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:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MI
Mailing Address - Zip Code:49756
Mailing Address - Country:US
Mailing Address - Phone:989-786-5288
Mailing Address - Fax:989-786-7349
Practice Address - Street 1:4556 SALLING AVENUE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MI
Practice Address - Zip Code:49756
Practice Address - Country:US
Practice Address - Phone:989-786-5288
Practice Address - Fax:989-786-7349
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor