Provider Demographics
NPI:1831273127
Name:WOODWARD, DAVID LEE JR (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:WOODWARD
Suffix:JR
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 1:314 HWY. 70 WEST
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532
Mailing Address - Country:US
Mailing Address - Phone:252-447-0791
Mailing Address - Fax:252-447-0791
Practice Address - Street 1:314 HWY. 70 WEST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532
Practice Address - Country:US
Practice Address - Phone:252-447-0791
Practice Address - Fax:252-447-0791
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0194LOtherCNC OF NC
NC8908939Medicaid
NC08939OtherBC/BS
NC0194LOtherCNC OF NC
NC08939OtherBC/BS