Healthcare Provider Details

I. General information

NPI: 1689647182
Provider Name (Legal Business Name): DEBORAH MARIE WOOD-SCHADE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAREBLU STE. 160
ALISO VIEJO CA
92656-3066
US

IV. Provider business mailing address

11 MAREBLU STE. 160
ALISO VIEJO CA
92656-3066
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-1500
  • Fax: 949-643-1671
Mailing address:
  • Phone: 949-643-1500
  • Fax: 949-643-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number20043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: