Provider Demographics
NPI:1871669846
Name:WOOD-ZANCHETTA, CAROL L (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:WOOD-ZANCHETTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26000 HARPER AVENUE SUITE A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-774-7920
Mailing Address - Fax:586-774-8336
Practice Address - Street 1:26000 HARPER AVENUE SUITE A
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-774-7920
Practice Address - Fax:586-774-8336
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005960111N00000X
MICW005960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4505020Medicaid
MI103477OtherGREAT LAKES HEALTH PLAN
MACW005960OtherWORK COMP
MICW005960OtherCOMMERCIAL
MI950E010690OtherBLUE CROSS
MI103477OtherGREAT LAKES HEALTH PLAN
MI4505020Medicaid
MI0M35060001Medicare PIN