NPI Code Detail JSON Logo

1265150908 NPI number — CARSON REED WILDE DC

NPI Number: 1265150908
Health Care Provider/Practitioner: CARSON REED WILDE DC

Information about “1265150908” NPI (CARSON REED WILDE DC) exists in 1265150908 in HTML format HTML  |  1265150908 in plain Text format TXT  |  1265150908 in PDF (Portable Document Format) PDF  |  1265150908 in an XML format XML  formats.

NPI Number : 1265150908 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265150908",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILDE",
    "FirstName": "CARSON",
    "MiddleName": "REED",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2247 S HARPER",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MESA",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85209-2423",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1184 N GILBERT RD STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GILBERT",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85234-2476",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "480-903-8008",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/18/2022",
    "LastUpdateDate": "08/18/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "9201",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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