Healthcare Provider Details

I. General information

NPI: 1497770515
Provider Name (Legal Business Name): GREGORY GUY WOOD D.C./QME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 BRISTOL ST STE 130
COSTA MESA CA
92626-8606
US

IV. Provider business mailing address

1202 BRISTOL ST STE 130
COSTA MESA CA
92626-8606
US

V. Phone/Fax

Practice location:
  • Phone: 714-437-9663
  • Fax: 714-437-9631
Mailing address:
  • Phone: 714-437-9663
  • Fax: 714-437-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC27192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: