Provider Demographics
NPI:1265416762
Name:WOODWARD, ROBERT P JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:WOODWARD
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4008 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1612
Mailing Address - Country:US
Mailing Address - Phone:502-366-1413
Mailing Address - Fax:502-366-1414
Practice Address - Street 1:4008 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1612
Practice Address - Country:US
Practice Address - Phone:502-366-1413
Practice Address - Fax:502-366-1414
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000181090OtherBC/BS
KY350046348OtherRAILROAD MEDICARE
KY6083401Medicare PIN