Provider Demographics
NPI:1831256486
Name:WISDO, RAYMOND GERARD (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:GERARD
Last Name:WISDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:540 LIMEKILN PIKE
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2900
Mailing Address - Country:US
Mailing Address - Phone:215-540-0101
Mailing Address - Fax:215-542-0800
Practice Address - Street 1:1308 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-1612
Practice Address - Country:US
Practice Address - Phone:610-532-0657
Practice Address - Fax:610-532-4258
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002552L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor