Provider Demographics
NPI:1194724989
Name:WADE, DAVID EDWARD (DC, MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:WADE
Suffix:
Gender:M
Credentials:DC, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1794
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1794
Mailing Address - Country:US
Mailing Address - Phone:256-237-9423
Mailing Address - Fax:256-237-6007
Practice Address - Street 1:114 HAMRIC DR E STE 5
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2434
Practice Address - Country:US
Practice Address - Phone:256-237-9423
Practice Address - Fax:256-237-6007
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1059111NI0013X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
6213099743OtherFMCSA
ALT68610Medicare UPIN