Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 5233 | AZ |
NPI | 1053329292 |
---|---|
Provider Name | Dr. Christopher Ray Wood |
First Address | Phoenix, AZ 85032-9306 |
Second Address | Phoenix, AZ 85032-9306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70427 | (02) | AZ |