Doctor Name: | DR. JEFFREY LEE WILD |
NPI Number: | 1851419048 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.C. |
License Number: | 2080-012 |
Business Practice Address: | 729 Pennsylvania Ave Sheboygan, WI - 530814644 |
Business Phone Number: | 9204588886 |
Business Fax Number: | 9204581128 |
Mailing Address: | 4719 Horseleap Ln, SHEBOYGAN |
State: | WI |
Postal Code: | 530835603 |
Phone Number: | 9204580110 |
Fax Number: | |
NPI Enumeration Date: | 03/26/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 2080-012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |