Individual
BRADLEY DALE WILDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
333 N 8TH ST, MEDFORD, WI 54451-1515
(715) 748-2334
Mailing address
333 N 8TH ST, MEDFORD, WI 54451-1515
(715) 748-2334
(715) 748-1124
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1600-012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38764400
—
WI
01
—
38987200
MEDICAID GROUP
WI
Enumeration date
07/18/2006
Last updated
04/16/2024
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