Provider Demographics
NPI:1194259093
Name:WILDER, LINDSEY (DC)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 YORK RD
Mailing Address - Street 2:STE 70
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2865
Mailing Address - Country:US
Mailing Address - Phone:267-518-3223
Mailing Address - Fax:
Practice Address - Street 1:610 YORK RD
Practice Address - Street 2:STE 70
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2865
Practice Address - Country:US
Practice Address - Phone:267-518-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor