Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 5651 | OR |
Y | 175F00000X | Naturopath | 3093 | OR |
NPI | 1255461224 |
---|---|
Provider Name | Ryan R Wood |
First Address | Lake Oswego, OR 97034-3228 |
Second Address | Lake Oswego, OR 97034-3228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 30/03/2017 |