Provider Demographics
NPI:1487144911
Name:WOOD, DALTON KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:DALTON
Middle Name:KYLE
Last Name:WOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 NANTUCKET DR APT D
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-3648
Mailing Address - Country:US
Mailing Address - Phone:662-266-3258
Mailing Address - Fax:
Practice Address - Street 1:757 FIFE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2423
Practice Address - Country:US
Practice Address - Phone:937-382-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor