Provider Demographics
NPI:1134179468
Name:WOOD, RON A (DC)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:A
Last Name:WOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1901 N GLENOAKS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3800
Mailing Address - Country:US
Mailing Address - Phone:818-557-1337
Mailing Address - Fax:818-557-7635
Practice Address - Street 1:1901 N GLENOAKS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3800
Practice Address - Country:US
Practice Address - Phone:818-557-1337
Practice Address - Fax:818-557-7635
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC22897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU47204Medicare UPIN