Provider Demographics
NPI:1811193022
Name:WOOTENCHIROPRACTIC AND PREEMPLOYMENT SERVICES
Entity Type:Organization
Organization Name:WOOTENCHIROPRACTIC AND PREEMPLOYMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-331-0208
Mailing Address - Street 1:301 JACKSON AVE S
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2206
Mailing Address - Country:US
Mailing Address - Phone:256-331-0208
Mailing Address - Fax:256-331-0308
Practice Address - Street 1:301 JACKSON AVE S
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2206
Practice Address - Country:US
Practice Address - Phone:256-331-0208
Practice Address - Fax:256-331-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU69697Medicare UPIN