Provider Demographics
NPI:1386857464
Name:WOOD, GARY RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RAY
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 1:175 S. UNION BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910
Mailing Address - Country:US
Mailing Address - Phone:719-473-7000
Mailing Address - Fax:719-473-7479
Practice Address - Street 1:175 S. UNION BLVD STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-473-7000
Practice Address - Fax:719-473-7479
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4270111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician