Provider Demographics
NPI:1811917966
Name:WOOD, BRANDON LUCAS (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LUCAS
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 1:220 FRANKFORT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1079
Mailing Address - Country:US
Mailing Address - Phone:859-873-2077
Mailing Address - Fax:859-873-2077
Practice Address - Street 1:220 FRANKFORT ST STE 4
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1079
Practice Address - Country:US
Practice Address - Phone:859-873-2077
Practice Address - Fax:859-873-2077
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0998301Medicare ID - Type Unspecified
KYV02497Medicare UPIN