Provider Demographics
NPI:1699475863
Name:WILDE, SETH D (DC)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:D
Last Name:WILDE
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 1:2083 W SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6779
Mailing Address - Country:US
Mailing Address - Phone:602-904-2513
Mailing Address - Fax:
Practice Address - Street 1:3303 S LINDSAY RD STE 119A
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2100
Practice Address - Country:US
Practice Address - Phone:480-605-1975
Practice Address - Fax:480-605-3728
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor