MEDICARE: CAMILLE M. WOOD DC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	1090	SD

General Provider Information

NPI Number	:	1548324742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMILLE M. WOOD DC PC

Provider Business Mailing Address
First Line	:	1122 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-4335
Country	:	US
Telephone Number	:	605-388-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 JACKSON BLVD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-4335
Country	:	US
Telephone Number	:	605-388-0406
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CAMILLE M. WOOD
Credential	:	DC
Telephone Number	:	605-388-0406

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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