Provider Demographics
NPI:1801922943
Name:WOOD CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:WOOD CHIROPRACTIC CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:REID
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-594-4223
Mailing Address - Street 1:5430 A POWERS CENTER PT.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7154
Mailing Address - Country:US
Mailing Address - Phone:719-594-4223
Mailing Address - Fax:719-282-1332
Practice Address - Street 1:5430 A POWERS CENTER PT.
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7154
Practice Address - Country:US
Practice Address - Phone:719-594-4223
Practice Address - Fax:719-282-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4771261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC46143Medicare ID - Type Unspecified