Provider Demographics
NPI:1861604860
Name:CHRISTOPHER J WOODROW, D.C., P.C.
Entity type:Organization
Organization Name:CHRISTOPHER J WOODROW, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WOODROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-864-5566
Mailing Address - Street 1:103 E ASHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:MT. ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1272
Mailing Address - Country:US
Mailing Address - Phone:217-864-5566
Mailing Address - Fax:217-864-4497
Practice Address - Street 1:103 E ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:MT. ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1272
Practice Address - Country:US
Practice Address - Phone:217-864-5566
Practice Address - Fax:217-864-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038006572Medicaid
ILT37629Medicare UPIN
IL913451Medicare ID - Type Unspecified
IL038006572Medicaid