Provider Demographics
NPI:1316084023
Name:WOOD FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:WOOD FAMILY CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-895-2225
Mailing Address - Street 1:205 N CHESTNUT ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1280
Mailing Address - Country:US
Mailing Address - Phone:507-895-2225
Mailing Address - Fax:507-895-7508
Practice Address - Street 1:205 N CHESTNUT ST
Practice Address - Street 2:SUITE 108
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1280
Practice Address - Country:US
Practice Address - Phone:507-895-2225
Practice Address - Fax:507-895-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4673111N00000X
WI3775-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN487R1CHOtherMN BCBS PROVIDER #
WI38961500Medicaid
U84754Medicare UPIN