Healthcare Provider Details

I. General information

NPI: 1598986242
Provider Name (Legal Business Name): TROY D WOOD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 WALLACE AVE
LEITCHFIELD KY
42754-1416
US

IV. Provider business mailing address

702 WALLACE AVE
LEITCHFIELD KY
42754-1416
US

V. Phone/Fax

Practice location:
  • Phone: 270-230-1122
  • Fax:
Mailing address:
  • Phone: 270-230-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4351
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: