Provider Demographics
NPI:1790034106
Name:WOOD, JESSE (DC,)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
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 1:7319 RIVER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6951
Mailing Address - Country:US
Mailing Address - Phone:501-753-5555
Mailing Address - Fax:501-753-5563
Practice Address - Street 1:7319 RIVER POINTE DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-6951
Practice Address - Country:US
Practice Address - Phone:501-753-5555
Practice Address - Fax:501-753-5563
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor