De Wild Chiropractic Center, INC

NPI #1912054677 in Red Bud, Illinois

Provider Information

NPI Number: 1912054677
Entity Type: Organization
Organization Name: De Wild Chiropractic Center, INC
Primary Specialty: Chiropractor
Enumeration Date: Jan 4, 2007
Last Updated: Aug 29, 2007

Practice Location

Address: 930 W MARKET ST
Address 2: SUITE 1
City: Red Bud
State: Illinois
ZIP Code: 62278-1006
Phone: (618) 282-3900

Authorized Official

Name: DR. JENNIFER RANEE DEWILDE, D.C.
Title: PRESIDENT
Phone: (618) 282-3900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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