MEDICARE: BRADLEY DALE WILDBERG DC

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	1600-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528086311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY DALE WILDBERG DC

Provider Business Mailing Address
First Line	:	333 N 8TH ST
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1515
Country	:	US
Telephone Number	:	715-748-2334
Fax Number	:	715-748-1124

Provider Business Practice Location Address
First Line	:	333 N 8TH ST
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1515
Country	:	US
Telephone Number	:	715-748-2334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/16/2024

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Directions to “ BRADLEY DALE WILDBERG DC” Practice Location

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