Andrew Wildwood, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC181041 Issued in OR

Practice address

1540 SE Clinton St
Portland, OR 97202-1130

Phone

(971) 319-0171

NPI assigned

Jun 21, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498003200000",
    "number": "1346760337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 SE CLINTON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 SE CLINTON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021130",
            "telephone_number": "971-319-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDWOOD",
        "first_name": "ANDREW",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-21",
        "last_updated": "2017-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC181041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wildwood Dental LLC
• Wildwood Electrolysis LLC
• Wildwood Family Medicine, LLC
• Wildwood Healing LLC
• Wildwood Reconnections LLC
• Sarah Arlee Wildwood, LPCA
• Robert Michael Wilechansky, M.D.
• David B. Wiley, DMD
• Jenna Marie Wiley, MD
• Keri Wiley, CADC-R, QMHA-R

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.