Individual
DR. MICHAEL R WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3460 LAUDERDALE DR, RICHMOND, VA 23233-7529
(804) 360-2273
(804) 360-7996
Mailing address
3460 LAUDERDALE DR, RICHMOND, VA 23233-7529
(804) 360-2273
(804) 360-7996
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104001090
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181767
BCBS
VA
01
—
54 1910925
TAX ID
VA
Enumeration date
11/09/2006
Last updated
06/19/2008
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