=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699475863
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SETH D WILDE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2023
-----------------------------------------------------
Last Update Date | 05/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3303 S LINDSAY RD STE 119A
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85297-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-605-1975
-----------------------------------------------------
Fax | 480-605-3728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2083 W SPRUCE DR
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85286-6779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-904-2513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9342
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------