DR. JORDAN WILLIAM WILDE (NPI# 1922370543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922370543 |
| Entity Type | Individual |
| Full Name | DR. JORDAN WILLIAM WILDE |
| Credential | D.C. |
| Practice Address |
191 Se Stark Street Gresham OR 97233-8386 |
| Mailing Address |
15777 Se Ruby Dr Milwaukie OR 97267-3703 |
| Practice Telephone | 5033289300 |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2020-10-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 5033 | OR | Chiropractic Providers |
| Street Address |
191 SE STARK STREET |
| City | GRESHAM |
| State | OR |
| Zip Code | 97233-8386 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205448164 | Moore Therapy Services, LLC | Behavioral Analyst | 2053 Se 181st Ave, Portland, OR 97233 | 2020-08-20 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1427573443 | Sunshine Ahc | In Home Supportive Care | 2217 Se 156th Ave, Portland, OR 97233 | 2017-08-10 |
| 1538609433 | Nathaniel Davis Jr. | Counselor | 8915 Se Center St, Tigard, OR 97233 | 2017-02-27 |
| 1154878627 | Oregon Outreach Inc | Case Management | 1740 South East 139th Avenue, Portland, OR 97233 | 2016-09-01 |
| 1023461019 | Julianne Baltzley | Counselor | 2409 Se 149th Avenue, Portland, OR 97233 | 2016-07-14 |
| 1710332143 | Emma Slater | Counselor | 12360 Se Burnside, Portland, OR 97233 | 2016-05-04 |
| 1245621952 | Gregory Brett Bledsoe | Counselor | 1427 Se 182nd Ave., Portland, OR 97233 | 2015-02-17 |
| 1396149852 | Jacqueline Bension | Counselor | 1705 Se 122nd Ave, Portland, OR 97233 | 2014-10-13 |
| 1700206950 | Olga I Zlatova I | Dental Hygienist | 325 Se 154th Ave, Portland, OR 97233 | 2014-04-25 |
| Find all providers in zip 97233 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720502180 | Ruslan Perederey | Chiropractor | 3008 Sw Chastain Ave, Gresham, OR 97080-9613 | 2017-07-27 |
| 1922473719 | Amplife Chiropractic and Sports Chiropractic | Chiropractor | 355 Ne 223rd Ave, Gresham, OR 97030-8554 | 2015-12-05 |
| 1972996874 | Kari Johnston | Chiropractor | 1167 Nw Wallula Avenue, #316, Gresham, OR 97030 | 2015-03-17 |
| 1386047751 | Sylas Takamune | Chiropractor | 2519 W Powell Blvd, Gresham, OR 97030-6413 | 2014-09-30 |
| 1780923532 | Aspire Chiropractic & Massage Inc. | Chiropractor | 22124 Ne Glisan St, Gresham, OR 97030-8553 | 2013-02-13 |
| 1487948212 | Delplato Chiropractic, PC | Chiropractor | 25500 Se Stark St Ste 201b, Gresham, OR 97030-8328 | 2011-06-09 |
| 1063704427 | Renewal Centers | Chiropractor | 1240 Ne Burnside Rd, Gresham, OR 97030-5713 | 2011-05-04 |
| 1326358417 | Shelley Anne Sheridan | Chiropractor | 250 Nw Norman Ave, Gresham, OR 97030-6953 | 2010-10-07 |
| 1528384625 | Aaron Montgomery | Chiropractor | 1304 Nw Civic Dr, Gresham, OR 97030-5569 | 2010-04-14 |
| 1396978011 | Brent Alan Dixson | Chiropractor | 899 Ne Hogan Dr, Gresham, OR 97030-5825 | 2009-08-27 |
| Find all providers in GRESHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.