Emanuel Dwayne Wilson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH13648 Issued in FL

Practice address

6349 Beach Blvd
Jacksonville, FL 32216-2707

Phone

(904) 400-8258

NPI assigned

Jul 28, 2021

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1225701048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6349 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162707",
            "telephone_number": "904-400-8258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6349 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322162707",
            "telephone_number": "904-400-8258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7962 Diamond Leaf Dr S",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322443455",
            "country_code": "US",
            "telephone_number": "904-525-5237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "EMANUEL",
        "middle_name": "DWAYNE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-28",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH13648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OP279",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea Wilson, BACHELOR LEVEL
• Claire Elizabeth Wilson, MD
• Courtney Wilson, MSW
• Courtney Elaine Wilson, DPT
• Eleni- Claire Wilson
• Frances Wilson
• Fred Wilson Sr.
• Fred Carter Wilson, D.C.
• Gail Wilson, MS
• George Rice Wilson III, MD

• Chiropractor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.