MEDICARE: WILDWOOD CHIROPRACTIC, INC

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

General Provider Information

NPI Number	:	1437371234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILDWOOD CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	8000 BONHOMME AVE STE 409
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-302-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 BONHOMME AVE STE 409
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-3515
Country	:	US
Telephone Number	:	314-302-0333
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TRACY LYNN EDELMANN
Credential	:	DC
Telephone Number	:	314-302-0333

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/27/2025

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Directions to “WILDWOOD CHIROPRACTIC, INC ” Practice Location

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