Provider Demographics
NPI:1588066385
Name:WOODRUM, ZACHARY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ALAN
Last Name:WOODRUM
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 1:103 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-3576
Mailing Address - Country:US
Mailing Address - Phone:304-389-1924
Mailing Address - Fax:
Practice Address - Street 1:4510 JEFFERIES HWY
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-6489
Practice Address - Country:US
Practice Address - Phone:843-539-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor