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Individual

DR. LARRY G WILDE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
246 S 1100 E, AMERICAN FORK, UT 84003-2829
(890) 175-6883
(801) 756-9014
Mailing address
219 E 1550 N, PLEASANT GROVE, UT 84062-9003
(801) 785-6784

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
290149-1202
UT

Other

Enumeration date
07/07/2006
Last updated
07/08/2007
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