MEDICARE: WILD CHIROPRACTIC, P.C.

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	1017	NE

General Provider Information

NPI Number	:	1831246990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	905 MAIN ST
Second Line	:
City	:	SEWARD
State	:	NE
Zip	:	68434-2047
Country	:	US
Telephone Number	:	402-643-6565
Fax Number	:	402-643-6565

Provider Business Practice Location Address
First Line	:	905 MAIN STREET
Second Line	:
City	:	SEWARD
State	:	NE
Zip	:	68434-2072
Country	:	US
Telephone Number	:	402-643-6565
Fax Number	:	402-643-6565

Authorized Official
Title or Position	:	CHIROPRACTOR OWNER
Name	:	DR. JOHN ANDREW WILD
Credential	:	D.C.
Telephone Number	:	402-643-6565

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	11/21/2016

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Directions to “WILD CHIROPRACTIC, P.C. ” Practice Location

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