MEDICARE: WILDWOOD CHIROPRACTIC CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4261	OTHER	MN	JOHN MACK LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3150	OTHER	MN	SCOTT DEPAULIS LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	2329	OTHER	MN	PATRICK G NAPOLI LICENSE
8	3051	OTHER	MN	DEAN JOY LICENSE

General Provider Information

NPI Number	:	1306827118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDWOOD CHIROPRACTIC CENTER PA

Provider Business Mailing Address
First Line	:	935 WILDWOOD RD
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55115-1847
Country	:	US
Telephone Number	:	651-779-4263
Fax Number	:	651-779-4274

Provider Business Practice Location Address
First Line	:	935 WILDWOOD RD
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55115-1847
Country	:	US
Telephone Number	:	651-779-4263
Fax Number	:	651-779-4274

Authorized Official
Title or Position	:	OWNER DR OF CHIROPRACTIC
Name	:	DR. PATRICK GERARD NAPOLI
Credential	:	DC
Telephone Number	:	651-779-4263

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	02/22/2010

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