Provider Demographics
NPI:1225170665
Name:WOOD, GEORGE ALBERT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALBERT
Last Name:WOOD
Suffix:JR
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 1:580 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1916
Mailing Address - Country:US
Mailing Address - Phone:508-853-2790
Mailing Address - Fax:508-853-2791
Practice Address - Street 1:580 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1916
Practice Address - Country:US
Practice Address - Phone:508-853-2790
Practice Address - Fax:508-853-2791
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA808111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1603400Medicaid
MA35213OtherHARVARD PILGRIM INS
MA715391OtherTUFTS INSURANCE
MA042894453 0003OtherCIGNA INS
MAY35555OtherBLUE CROSS BLUE SHIELD MA
MA042894453OtherCOMMONWEALTH OF MA