Provider Demographics
NPI:1881782621
Name:HARRIS, WOODROW BOLDEN III (DC)
Entity type:Individual
Prefix:DR
First Name:WOODROW
Middle Name:BOLDEN
Last Name:HARRIS
Suffix:III
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 1:4000 SUNRISE RD
Mailing Address - Street 2:BLDG. 1 STE. 1200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1519
Mailing Address - Country:US
Mailing Address - Phone:512-248-9355
Mailing Address - Fax:512-233-1010
Practice Address - Street 1:4000 SUNRISE RD
Practice Address - Street 2:BLDG. 1 STE. 1200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1519
Practice Address - Country:US
Practice Address - Phone:512-248-9355
Practice Address - Fax:512-233-1010
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00318024OtherRAILROAD MEDICARE
TX612357Medicare ID - Type Unspecified