Provider Demographics
NPI:1982657714
Name:WIGTON, CHRIS BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:BRADLEY
Last Name:WIGTON
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 1:420 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1110
Mailing Address - Country:US
Mailing Address - Phone:814-437-6808
Mailing Address - Fax:814-432-3601
Practice Address - Street 1:420 9TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1110
Practice Address - Country:US
Practice Address - Phone:814-437-6808
Practice Address - Fax:814-432-3601
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004746L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA683797OtherBC/BS
PAU20099Medicare UPIN
PA683797KGFMedicare PIN