Larry G Wilde, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

290149-1202 Issued in UT

Practice address

246 S 1100 E
American Fork, UT 84003-2829

Phone

(890) 175-6883

Fax

(801) 756-9014

NPI assigned

Jul 7, 2006

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

Enrolled in UT

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wilde Chiropractic, LLC

  • Chiropractor
  • American Fork, UT
  • NPI 1356454516
  Medicare reassignment NPD Authorized official
• Temple View Chiropractic Clinic, Inc

  • Clinic/Center
  • American Fork, UT
  • NPI 1194026914
  NPD
• Mark Henry Radandt

  • Chiropractor
  • American Fork, UT
  • NPI 1871752642
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770515934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 E 1550 N",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840629003",
            "telephone_number": "801-785-6784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 S 1100 E",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840032829",
            "telephone_number": "890-175-6883",
            "fax_number": "801-756-9014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "LARRY",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "290149-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank M Whitney, RPH
• Christopher Jay Wilcox, PA
• Jeffrey Dallin Wilcox, M.D.
• Ryan B Wilcox, M.D.
• Wilde Chiropractic, LLC
• Aaron Ezekiel Wilkerson, FNP-C
• Dalton Wilkes
• Phillip James Willard
• Jon Willardson
• Doris Willey

• All providers in American Fork, UT
• Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.