Healthcare Provider Details

I. General information

NPI: 1609604586
Provider Name (Legal Business Name): NICHOLAS LEE WOOD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 DOCTORS PARK DR
MEDFORD OR
97504-8127
US

IV. Provider business mailing address

891 OHARE PKWY
MEDFORD OR
97504-4005
US

V. Phone/Fax

Practice location:
  • Phone: 541-245-4444
  • Fax: 541-245-4443
Mailing address:
  • Phone: 541-245-4444
  • Fax: 541-200-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6393
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: