Provider Demographics
NPI:1912916727
Name:WOOSTER, RICK (DC)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:WOOSTER
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 1:1 SHERINGTON DR
Mailing Address - Street 2:SIUTE E
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6018
Mailing Address - Country:US
Mailing Address - Phone:843-815-3400
Mailing Address - Fax:843-815-3402
Practice Address - Street 1:1 SHERINGTON DR
Practice Address - Street 2:SUITE E
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6018
Practice Address - Country:US
Practice Address - Phone:843-815-3400
Practice Address - Fax:843-815-3402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8781OtherMEDICARE PTAN
SCU18083Medicare UPIN