Provider Demographics
NPI:1770801490
Name:WOOD, KENNETH ALAN (DC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ALAN
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 1:6717 S 900 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5754
Mailing Address - Country:US
Mailing Address - Phone:801-432-7511
Mailing Address - Fax:801-432-7516
Practice Address - Street 1:6717 S 900 E
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5754
Practice Address - Country:US
Practice Address - Phone:801-432-7511
Practice Address - Fax:801-432-7516
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT295215-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor