Provider Demographics
NPI:1427101849
Name:WOOD, SHELLI MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:SHELLI
Middle Name:MARIE
Last Name:WOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 28TH ST SE STE 16
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6931
Mailing Address - Country:US
Mailing Address - Phone:616-285-5441
Mailing Address - Fax:616-285-5442
Practice Address - Street 1:6161 28TH ST SE STE 16
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6931
Practice Address - Country:US
Practice Address - Phone:616-285-5441
Practice Address - Fax:616-285-5442
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N51570Medicare ID - Type Unspecified