Provider Demographics
NPI:1295839389
Name:EASTWOOD, JODY RYAN (DC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:RYAN
Last Name:EASTWOOD
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 1:100 PEYTON WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8572
Mailing Address - Country:US
Mailing Address - Phone:304-720-2005
Mailing Address - Fax:304-720-2009
Practice Address - Street 1:100 PEYTON WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8572
Practice Address - Country:US
Practice Address - Phone:304-720-2005
Practice Address - Fax:304-720-2009
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001813057OtherBLUE CROSS BLUE SHIELD WV
WV9371471Medicare PIN