Provider Demographics
NPI:1255447033
Name:ADAM L. WILDING, D.C., P.C.
Entity type:Organization
Organization Name:ADAM L. WILDING, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:WILDING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-220-9670
Mailing Address - Street 1:140 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3374
Mailing Address - Country:US
Mailing Address - Phone:757-220-9670
Mailing Address - Fax:757-564-1197
Practice Address - Street 1:140 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3374
Practice Address - Country:US
Practice Address - Phone:757-220-9670
Practice Address - Fax:757-564-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA143000OtherANTHEM
VA3182289OtherCIGNA
VA10390667OtherCAQH NETWORK
VA20014200OtherVHN
VA7223005OtherAETNA
VADC3738OtherRAILROAD MEDICARE GROUP #
VA3182289OtherCIGNA
VA10390667OtherCAQH NETWORK
VA7223005OtherAETNA
VA20014200OtherVHN
VA143000OtherANTHEM