Healthcare Provider Details

I. General information

NPI: 1790991453
Provider Name (Legal Business Name): DR TOM A WOOD CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6108 S 31ST STREET
FT SMITH AR
72908
US

IV. Provider business mailing address

6108 S 31ST STREET
FT SMITH AR
72908
US

V. Phone/Fax

Practice location:
  • Phone: 479-646-0294
  • Fax: 479-646-0416
Mailing address:
  • Phone: 479-646-0294
  • Fax: 479-646-0416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number862
License Number StateAR

VIII. Authorized Official

Name: DR. TOM A WOOD
Title or Position: DR OWNER
Credential: DC
Phone: 479-646-0294