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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