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Organization
DE WILD CHIROPRACTIC CENTER, INC
Active
Organization
DE WILD CHIROPRACTIC CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER RANEE DEWILDE D.C. (PRESIDENT)
(618) 282-3900
Entity
Organization
Contact information
Practice address
930 W MARKET ST, SUITE 1, RED BUD, IL 62278-1006
(618) 282-3900
(618) 282-3971
Mailing address
930 W MARKET ST, SUITE 1, RED BUD, IL 62278-1006
(618) 282-3900
(618) 282-3971
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
671268
UHC
IL
01
—
7932010
BCBS
IL
Enumeration date
01/04/2007
Last updated
08/29/2007
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