Provider Demographics
NPI:1710725502
Name:WILDER, ALISON M (DC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:M
Last Name:WILDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6932 SE 108TH AVE
Mailing Address - Street 2:APT, SUITE, BLDG. (OPTIONAL)
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266
Mailing Address - Country:US
Mailing Address - Phone:414-238-8355
Mailing Address - Fax:
Practice Address - Street 1:1330 SE CESAR ESTRADA CHAVEZ BLVD
Practice Address - Street 2:APT, SUITE, BLDG. (OPTIONAL)
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:414-238-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor