Provider Demographics
NPI:1548296510
Name:WILDERMAN, CHRISTOPHER A (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:WILDERMAN
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 1:2416 BLOOMER DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4809
Mailing Address - Country:US
Mailing Address - Phone:618-433-8913
Mailing Address - Fax:618-433-8915
Practice Address - Street 1:2416 BLOOMER DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4809
Practice Address - Country:US
Practice Address - Phone:618-433-8913
Practice Address - Fax:618-433-8915
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4404400OtherUNITED HEALTH CARE
IL6082010OtherBLUE CROSS BLUE SHEILD
MO116888OtherBLUE CORSS BLUE SHEILD MO
IL038008175Medicaid
IL5718545OtherAEATNA HEALTHCARE
IL325539OtherHEALTHLINK
MO10481T1OtherBCBS ALLIANCE
IL5718545OtherAEATNA HEALTHCARE