Provider Demographics
NPI:1023199692
Name:WOOD, RICHARD C (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:WOOD
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 1:202 E US HIGHWAY 80 STE 3
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-2104
Mailing Address - Country:US
Mailing Address - Phone:903-759-4778
Mailing Address - Fax:903-297-8031
Practice Address - Street 1:202 E US HIGHWAY 80 STE 3
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693-2104
Practice Address - Country:US
Practice Address - Phone:903-759-4778
Practice Address - Fax:903-297-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014151-01Medicaid
T16727Medicare UPIN
TX601956Medicare ID - Type Unspecified