Provider Demographics
NPI:1184745978
Name:WOODCOCK CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:WOODCOCK CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-254-8335
Mailing Address - Street 1:491 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8015
Mailing Address - Country:US
Mailing Address - Phone:802-254-8335
Mailing Address - Fax:802-257-0993
Practice Address - Street 1:491 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:VT
Practice Address - Zip Code:05301-8015
Practice Address - Country:US
Practice Address - Phone:802-254-8335
Practice Address - Fax:802-257-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060000577111NR0200X
VT0060000767111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0352966OtherBLUE CROSS BLUE SHIELD
VT0352966OtherBLUE CROSS BLUE SHIELD