Provider Demographics
NPI:1902001415
Name:WOOLMAN, WILLIAM JAY (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAY
Last Name:WOOLMAN
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17233 140TH AVE SE
Mailing Address - Street 2:STE 100
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7013
Mailing Address - Country:US
Mailing Address - Phone:425-226-4823
Mailing Address - Fax:425-271-6498
Practice Address - Street 1:17233 140TH AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7013
Practice Address - Country:US
Practice Address - Phone:425-226-4823
Practice Address - Fax:425-271-6498
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01914Medicare UPIN