Individual
ANDREA WILDEROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
604 12TH ST, WEST COLUMBIA, SC 29169-6337
(803) 888-6385
Mailing address
1119 HULON LN, WEST COLUMBIA, SC 29169-3444
(915) 588-5793
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5058
SC
Other
Enumeration date
02/19/2024
Last updated
03/04/2024
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