Jacob Wilson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

12405 Issued in AR

Practice address

572 E Centerton Blvd
Centerton, AR 72719-6072

Phone

(479) 323-1010

NPI assigned

Oct 19, 2020

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

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.

• Ozark Family Chiropractic LLC

  dba Ozark Family Chiropractic

  • Chiropractor
  • Centerton, AR
  • NPI 1538986211
  NPD Authorized official
• Freeform Chiropractic Trophy Club LLC

  • Chiropractor
  • Trophy Club, TX
  • NPI 1861025611
  NPD
• Cornerstone Chiropractic III LLC

  • Chiropractor
  • Melissa, TX
  • NPI 1619611217
  NPD (past)

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

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1043819303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "572 E CENTERTON BLVD",
            "city": "CENTERTON",
            "state": "AR",
            "postal_code": "727196072",
            "telephone_number": "479-323-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 E CENTERTON BLVD",
            "city": "CENTERTON",
            "state": "AR",
            "postal_code": "727196072",
            "telephone_number": "479-323-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACOB",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-19",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "14514",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "12405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren R Wall, PTA
• Bronte Carinn Welker, APRN
• Celeste Sarene Williams, APRN
• Melinda Long Williams, D.P.T.
• Kynnedy B Willson, DDS
• Mark Wiseman
• Amber Woods, NP
• Andrea J Yates, M.S. CCC-SLP
• Youth Bridge

• Chiropractor in Centerton, AR
• Providers in Centerton, AR by specialty
• Chiropractor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.