NPIMap

Individual provider Active NPI

Kenneth Alan Wood, D.C.

  • Chiropractor
  • Midvale, UT
National Provider Identifier
1770801490
Registry record updated May 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
295215-1202 Issued in UT
Practice address
6717 S 900 E
Suite 101
Midvale, UT 84047-5754
Phone
(801) 432-7511
Fax
(801) 432-7516
NPI assigned
May 5, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 295215-1202 UT Primary

Addresses

Primary practice location

6717 S 900 E
Suite 101
Midvale, UT 84047-5754

Mailing address

6717 S 900 E
Suite 101
Midvale, UT 84047-5754
Phone (801) 432-7511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
295215-1202UTMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Brad Young D.C., P.C. Chiropractor Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273017600000",
    "number": "1770801490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6717 S 900 E",
            "address_2": "SUITE 101",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840475754",
            "telephone_number": "801-432-7511",
            "fax_number": "801-432-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6717 S 900 E",
            "address_2": "SUITE 101",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840475754",
            "telephone_number": "801-432-7511",
            "fax_number": "801-432-7516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "KENNETH",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-05",
        "last_updated": "2010-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "295215-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midvale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.