Provider Demographics
NPI:1174662662
Name:WOOD CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:WOOD CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-873-2077
Mailing Address - Street 1:220 FRANKFORT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1079
Mailing Address - Country:US
Mailing Address - Phone:859-873-2077
Mailing Address - Fax:859-873-2077
Practice Address - Street 1:220 FRANKFORT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1079
Practice Address - Country:US
Practice Address - Phone:859-873-2077
Practice Address - Fax:859-873-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003903Medicaid
KYV02497Medicare UPIN
KY85003903Medicaid