Provider Demographics
NPI:1043315526
Name:WOODS, STEPHEN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:WOODS
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 1:5400 N ILLINOIS ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3563
Mailing Address - Country:US
Mailing Address - Phone:618-235-1500
Mailing Address - Fax:618-235-1501
Practice Address - Street 1:5400 N ILLINOIS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3563
Practice Address - Country:US
Practice Address - Phone:618-235-1500
Practice Address - Fax:618-235-1501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2632008OtherBLUE CROSS BLUE SHIELD
IL038-009938Medicaid
IL612200OtherHEALTHLINK
IL612200OtherHEALTHLINK