Provider Demographics
NPI:1043298383
Name:WOOD, DERRICK MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:MATTHEW
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 1:201 HWY 463 SOUTH
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472
Mailing Address - Country:US
Mailing Address - Phone:870-483-6353
Mailing Address - Fax:870-483-9663
Practice Address - Street 1:201 HWY 463 SOUTH
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472
Practice Address - Country:US
Practice Address - Phone:870-483-6353
Practice Address - Fax:870-483-9663
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150513718Medicaid
AR150513718Medicaid
U72230Medicare UPIN