Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 1707 | WI |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1707 | WI |
NPI | 1417929621 |
---|---|
Provider Name | Dr. Jeffrey M. Wilder |
First Address | Madison, WI 53704-3702 |
Second Address | Madison, WI 53704-3702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 25/10/2010 |