Provider Demographics
NPI:1588736029
Name:WOODS, KERRY BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:BRIAN
Last Name:WOODS
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 1:16236 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2901
Mailing Address - Country:US
Mailing Address - Phone:562-947-2864
Mailing Address - Fax:562-947-1018
Practice Address - Street 1:16236 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2901
Practice Address - Country:US
Practice Address - Phone:562-947-2864
Practice Address - Fax:562-947-1018
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21571111N00000X
NYX010358-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0215710OtherBLUE CROSS
CADC0215710OtherBLUE CROSS