Provider Demographics
NPI:1831258870
Name:WOOD, MICHAEL WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
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 1:328 HOWARD ST W
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2306
Mailing Address - Country:US
Mailing Address - Phone:386-362-2022
Mailing Address - Fax:386-362-2011
Practice Address - Street 1:1441 OHIO AVE N
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4817
Practice Address - Country:US
Practice Address - Phone:386-362-2022
Practice Address - Fax:386-362-2011
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH008550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89034YMedicare ID - Type Unspecified