Provider Demographics
NPI:1952317992
Name:WOOLMAN, RICHARD J (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:WOOLMAN
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 1:2560 W BLOOMFIELD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3085
Mailing Address - Country:US
Mailing Address - Phone:248-366-8998
Mailing Address - Fax:
Practice Address - Street 1:26751 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4532
Practice Address - Country:US
Practice Address - Phone:248-552-0510
Practice Address - Fax:248-569-7741
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRW006163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4866695-14Medicaid
MI95-0-F3-25700OtherBCBS PIN
MIT33352Medicare UPIN