Provider Demographics
NPI:1841842077
Name:WOODEN, BRAKEN (DC)
Entity type:Individual
Prefix:
First Name:BRAKEN
Middle Name:
Last Name:WOODEN
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 1:1893 SKYLINE DR.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-621-1667
Mailing Address - Fax:801-605-3807
Practice Address - Street 1:1893 SKYLINE DR.
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-621-1667
Practice Address - Fax:801-605-3807
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11338371-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor