Provider Demographics
NPI:1417921099
Name:WOOD, LAWRENCE ALBERT V (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALBERT
Last Name:WOOD
Suffix:V
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 1:307 VILLAGE EDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7715
Mailing Address - Country:US
Mailing Address - Phone:570-992-1011
Mailing Address - Fax:570-402-3534
Practice Address - Street 1:307 VILLAGE EDGE DR
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-992-1011
Practice Address - Fax:570-402-3534
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009149111N00000X
MECR1415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAW01672673OtherBC/BS
PA088648TX8Medicare ID - Type Unspecified
PAW01672673OtherBC/BS