Provider Demographics
NPI:1184171282
Name:WOOD, MANDI (DC)
Entity type:Individual
Prefix:DR
First Name:MANDI
Middle Name:
Last Name:WOOD
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 1:3874 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3710
Mailing Address - Country:US
Mailing Address - Phone:573-243-8983
Mailing Address - Fax:573-243-7209
Practice Address - Street 1:3874 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3710
Practice Address - Country:US
Practice Address - Phone:573-243-8983
Practice Address - Fax:573-243-7209
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016026188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1144763756OtherGROUP NPI NUMBER
MOMA6572001Medicare Oscar/Certification