Provider Demographics
NPI:1073262788
Name:WISDOM, JOSEPH AARON (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:AARON
Last Name:WISDOM
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 1:3132 SW MARIGOLD ST APT 12
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5381
Mailing Address - Country:US
Mailing Address - Phone:714-200-6027
Mailing Address - Fax:
Practice Address - Street 1:2850 SE 82ND AVE UNIT 10
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1599
Practice Address - Country:US
Practice Address - Phone:503-777-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor