Basic Information
| Provider Information | |||||||||
| NPI: | 1003142241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1770 FORT UNION BLVD #101 | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD HEIGHTS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841212881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019445900 | ||||||||
| FaxNumber: | 8019445910 | ||||||||
| Practice Location | |||||||||
| Address1: | 6033 S FASHION POINT DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844034699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014756800 | ||||||||
| FaxNumber: | 8014756802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 7460477-1202 | UT | Y | Chiropractic Providers | Chiropractor |
No ID Information.