Provider Demographics
NPI:1699894147
Name:WOOD, LISA (D,C,)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1373
Mailing Address - Country:US
Mailing Address - Phone:508-429-8003
Mailing Address - Fax:
Practice Address - Street 1:118 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1373
Practice Address - Country:US
Practice Address - Phone:508-429-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1823111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36301Medicare ID - Type Unspecified