Jordan William Wilde, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5033 Issued in OR

Practice address

191 SE Stark Street
Gresham, OR 97233-8386

Phone

(503) 328-9300

NPI assigned

Jan 27, 2012

Last updated

Oct 13, 2020By the provider in NPPES

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 OR

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Milwaukie Spine and Sport, LLCGroup PAC ID 0446661730, 2 clinicians

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Milwaukie Spine and Sport, LLC

  • Health Service Clinic/Center
  • Milwaukie, OR
  • NPI 1679850010
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1327622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1922370543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15777 SE RUBY DR",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972673703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 SE STARK STREET",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "972338386",
            "telephone_number": "503-328-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "JORDAN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-27",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Whiting, LE
• Grace Whitty, CSWA
• Emily Wiessner
• Wild Earth Wellness
• Jeb Riley Wild, DPT
• Tiffany Wildes
• Wildflower Counseling Collective LLC
• Jessica Ann Wilkerson, APRN-NP
• Leah Leanne Wilkinson
• Bridgette Marie Wilkison, LMT, NCBTMB

• Chiropractor in Gresham, OR
• Providers in Gresham, OR by specialty
• Chiropractor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.