Basic Information
Provider Information
NPI: 1003142241
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOOD
FirstName: MATTHEW
MiddleName: PAUL
NamePrefix:  
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X7460477-1202UTY Chiropractic ProvidersChiropractor 

No ID Information.


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