Brian Peter Dewilde, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR010554 Issued in GA

Practice address

4294 Memorial Dr Ste D
Decatur, GA 30032-1226

Phone

(470) 231-5272

NPI assigned

Aug 19, 2021

Last updated

Aug 19, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1508532599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2479 CEDAR CANYON RD SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300676696",
            "telephone_number": "616-485-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4294 MEMORIAL DR STE D",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321226",
            "telephone_number": "470-231-5272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWILDE",
        "first_name": "BRIAN",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "9077",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR010554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katie Marie Dew, MD
• Paige Dewitt, MSCCCSLP
• Sydney Dewoody
• Ivy Delorse Dey-Johnson, MSW, LCSW
• Maryn Hayward Deyoung, PA-C, MPH
• Ajeet Dhingra, M.D.

• Chiropractor in Decatur, GA
• Providers in Decatur, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.