Provider Demographics
NPI:1053140954
Name:WOODEAN, TIMOTHY ROBERT (DC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:WOODEAN
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 1:4233 CAMBRIA WILSON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9797
Mailing Address - Country:US
Mailing Address - Phone:716-243-5136
Mailing Address - Fax:
Practice Address - Street 1:638 LAKE ST STE 3
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-9600
Practice Address - Country:US
Practice Address - Phone:716-751-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor