Provider Demographics
NPI:1902959562
Name:WEISS, WOOD M (DC)
Entity Type:Individual
Prefix:
First Name:WOOD
Middle Name:M
Last Name:WEISS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2555
Mailing Address - Country:US
Mailing Address - Phone:360-293-2011
Mailing Address - Fax:360-293-2009
Practice Address - Street 1:2320 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2555
Practice Address - Country:US
Practice Address - Phone:360-293-2011
Practice Address - Fax:360-293-2009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHOOOO2439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA58696OtherDEPT. OF LABOR & INDUSTRI
WA43199OtherREGENCE BLUE SHIELD
WA58696OtherDEPT. OF LABOR & INDUSTRI