Provider Demographics
NPI:1386614816
Name:WILDING, ADAM LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LEWIS
Last Name:WILDING
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 1:140 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3374
Mailing Address - Country:US
Mailing Address - Phone:757-220-9670
Mailing Address - Fax:757-564-1197
Practice Address - Street 1:140 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3374
Practice Address - Country:US
Practice Address - Phone:757-220-9670
Practice Address - Fax:757-564-1197
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7223005OtherAETNA
VA10390667OtherCAQH NETWORK
VAP00164621OtherRAILROAD MEDICARE
VA143001OtherBC/BS
VA3182289OtherCIGNA PROVIDER ID
VAU72958Medicare UPIN
VAC09201Medicare ID - Type UnspecifiedMEDICARE