Provider Demographics
NPI:1548277296
Name:WOOD, CHRISTOPHER DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:WOOD
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 1:205 N CHESTNUT ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947
Mailing Address - Country:US
Mailing Address - Phone:507-895-2225
Mailing Address - Fax:507-895-7508
Practice Address - Street 1:205 N CHESTNUT ST
Practice Address - Street 2:SUITE 108
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947
Practice Address - Country:US
Practice Address - Phone:507-895-2225
Practice Address - Fax:507-895-7508
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3775012111N00000X
MN4673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN487R1CHOtherBCBS
MN072408400OtherMN MED ASSISTANCE
WI38961500Medicaid
WI350003347Medicare ID - Type Unspecified
MN350003347Medicare ID - Type Unspecified
WI38961500Medicaid