Healthcare Provider Details

I. General information

NPI: 1023199692
Provider Name (Legal Business Name): RICHARD C WOOD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E US HIGHWAY 80 STE 3
WHITE OAK TX
75693-2104
US

IV. Provider business mailing address

202 E US HIGHWAY 80 STE 3
WHITE OAK TX
75693-2104
US

V. Phone/Fax

Practice location:
  • Phone: 903-759-4778
  • Fax: 903-297-8031
Mailing address:
  • Phone: 903-759-4778
  • Fax: 903-297-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC4715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: