Provider Demographics
NPI:1871600361
Name:WOOLSTON, JEFFERY DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DAVID
Last Name:WOOLSTON
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 1:9832 N HAYDEN RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1235
Mailing Address - Country:US
Mailing Address - Phone:480-556-6797
Mailing Address - Fax:480-556-6670
Practice Address - Street 1:9832 N HAYDEN RD STE 207
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1235
Practice Address - Country:US
Practice Address - Phone:480-556-6797
Practice Address - Fax:480-556-6670
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ5974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0937890OtherBC/BS
AZU81470Medicare UPIN
AZZ75869Medicare PIN