MEDICARE: DR. KATHY DIANE WOOD 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	005109	GA

General Provider Information

NPI Number	:	1740271154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY DIANE WOOD DC

Provider Business Mailing Address
First Line	:	301 DYKES ST SW
Second Line	:
City	:	COCHRAN
State	:	GA
Zip	:	31014-1837
Country	:	US
Telephone Number	:	478-934-8855
Fax Number	:	478-934-8855

Provider Business Practice Location Address
First Line	:	169 WEST DYKES ST
Second Line	:
City	:	COCHRAN
State	:	GA
Zip	:	31014-1837
Country	:	US
Telephone Number	:	478-934-8855
Fax Number	:	478-934-8855

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	08/11/2010

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Directions to “ DR. KATHY DIANE WOOD DC” Practice Location

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