Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7460477-1202 | UT |
NPI | 1003142241 |
---|---|
Provider Name | Matthew Paul Wood |
First Address | Cottonwood Heights, UT 84121-2881 |
Second Address | South Ogden, UT 84403-4699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2009 |
Last Update Date | 21/12/2015 |