Provider Demographics
NPI:1902849896
Name:WOOSLEY, JEFFREY E (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:E
Last Name:WOOSLEY
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 1:1018 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5208
Mailing Address - Country:US
Mailing Address - Phone:903-793-3532
Mailing Address - Fax:903-793-6098
Practice Address - Street 1:1018 OLIVE ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5208
Practice Address - Country:US
Practice Address - Phone:903-793-3532
Practice Address - Fax:903-793-6098
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601498Medicare ID - Type Unspecified