Provider Demographics
NPI:1720113970
Name:WOOD, JOHN A (DC, PS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:WOOD
Suffix:
Gender:M
Credentials:DC, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11027 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7205
Mailing Address - Country:US
Mailing Address - Phone:253-630-9395
Mailing Address - Fax:253-639-2219
Practice Address - Street 1:12950 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7940
Practice Address - Country:US
Practice Address - Phone:253-630-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8405029Medicaid
WA912094840OtherTAX ID
WA2012235Medicaid
WAGAB21435Medicare ID - Type Unspecified
WAGAB21434Medicare ID - Type Unspecified
WA2012235Medicaid