Provider Demographics
NPI:1346341765
Name:WILDENAUER, CHRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:WILDENAUER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2605
Mailing Address - Country:US
Mailing Address - Phone:516-781-1018
Mailing Address - Fax:516-679-2589
Practice Address - Street 1:2137 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2605
Practice Address - Country:US
Practice Address - Phone:516-781-1018
Practice Address - Fax:516-679-2589
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00318049OtherRAIL ROAD MEDICARE
NYP2115919OtherOXFORD ID NUMBER
NYP00318049OtherRAIL ROAD MEDICARE