MEDICARE: DR. KERRY BRIAN WOODS DC

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	111N00000X	Chiropractor	21571	CA
2	111N00000X	Chiropractor	X010358-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0215710	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1588736029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY BRIAN WOODS DC

Provider Business Mailing Address
First Line	:	16236 WHITTIER BLVD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-2901
Country	:	US
Telephone Number	:	562-947-2864
Fax Number	:	562-947-1018

Provider Business Practice Location Address
First Line	:	16236 WHITTIER BLVD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-2901
Country	:	US
Telephone Number	:	562-947-2864
Fax Number	:	562-947-1018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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