Individual
DR. JORDAN WILLIAM WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
191 SE STARK STREET, GRESHAM, OR 97233-8386
(503) 328-9300
Mailing address
15777 SE RUBY DR, MILWAUKIE, OR 97267-3703
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5033
OR
Other
Enumeration date
01/27/2012
Last updated
10/13/2020
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