Provider Demographics
NPI:1255543625
Name:WOODBURY, IAN PETER (DC)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:PETER
Last Name:WOODBURY
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 1:10909 FAIRCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4807
Mailing Address - Country:US
Mailing Address - Phone:571-426-0756
Mailing Address - Fax:703-360-3178
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 201
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-360-8200
Practice Address - Fax:703-360-3178
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor