Provider Demographics
NPI:1053557983
Name:WOOD, PENNY SUE (DC)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:SUE
Last Name:WOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2907
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-2907
Mailing Address - Country:US
Mailing Address - Phone:425-823-6702
Mailing Address - Fax:425-823-6703
Practice Address - Street 1:9833 NE 120TH PL STE C
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4266
Practice Address - Country:US
Practice Address - Phone:425-823-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACHOOOO2712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor