Healthcare Provider Details

I. General information

NPI: 1194724989
Provider Name (Legal Business Name): DAVID EDWARD WADE DC, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HAMRIC DR E STE 5
OXFORD AL
36203-2434
US

IV. Provider business mailing address

PO BOX 1794
ANNISTON AL
36202-1794
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-9423
  • Fax: 256-237-6007
Mailing address:
  • Phone: 256-237-9423
  • Fax: 256-237-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1059
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number1059
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: