Provider Demographics
NPI:1295950921
Name:WOOTEN, JIMMIE NATHAN IV (DC)
Entity type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:NATHAN
Last Name:WOOTEN
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:816 W MCDERMOTT DR STE 324
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6505
Mailing Address - Country:US
Mailing Address - Phone:972-383-9545
Mailing Address - Fax:
Practice Address - Street 1:816 W MCDERMOTT DR STE 324
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6505
Practice Address - Country:US
Practice Address - Phone:972-383-9545
Practice Address - Fax:214-575-8855
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10584111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation