Healthcare Provider Details

I. General information

NPI: 1255932091
Provider Name (Legal Business Name): DOMINIK WOODS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 TANK FARM RD STE 110
SAN LUIS OBISPO CA
93401-7084
US

IV. Provider business mailing address

187 TANK FARM RD STE 110
SAN LUIS OBISPO CA
93401-7084
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-0204
  • Fax: 805-439-0846
Mailing address:
  • Phone: 805-439-0204
  • Fax: 805-439-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: