Healthcare Provider Details

I. General information

NPI: 1548277296
Provider Name (Legal Business Name): CHRISTOPHER DAVID WOOD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N CHESTNUT ST SUITE 108
LA CRESCENT MN
55947
US

IV. Provider business mailing address

205 N CHESTNUT ST SUITE 108
LA CRESCENT MN
55947
US

V. Phone/Fax

Practice location:
  • Phone: 507-895-2225
  • Fax: 507-895-7508
Mailing address:
  • Phone: 507-895-2225
  • Fax: 507-895-7508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3775012
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4673
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: