MEDICARE: DR. LAWRENCE ALBERT WOOD V DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC009149	PA
2	111N00000X	Chiropractor	CR1415	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W01672673	OTHER	PA	BC/BS

General Provider Information

NPI Number	:	1417921099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE ALBERT WOOD V DC

Provider Business Mailing Address
First Line	:	307 VILLAGE EDGE DR
Second Line	:
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322-7715
Country	:	US
Telephone Number	:	570-992-1011
Fax Number	:	570-402-3534

Provider Business Practice Location Address
First Line	:	307 VILLAGE EDGE DR
Second Line	:
City	:	BRODHEADSVILLE
State	:	PA
Zip	:	18322
Country	:	US
Telephone Number	:	570-992-1011
Fax Number	:	570-402-3534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	12/13/2016

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