Provider Demographics
NPI:1821152703
Name:WOOG, KEVIN MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARK
Last Name:WOOG
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 1:61450 DUNCAN LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2133
Mailing Address - Country:US
Mailing Address - Phone:541-617-1413
Mailing Address - Fax:
Practice Address - Street 1:1900 NE DIVISION ST
Practice Address - Street 2:106
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3525
Practice Address - Country:US
Practice Address - Phone:541-312-5351
Practice Address - Fax:541-312-5352
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor