Kaleb Joe Wilson, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038013751 Issued in IL

Practice address

1713 Fort Jesse Rd Ste D
Normal, IL 61761-6235

Phone

(309) 862-2225

NPI assigned

Aug 30, 2021

Last updated

Aug 30, 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 1

Addresses

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": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1336817097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 FORT JESSE RD STE D",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616235",
            "telephone_number": "309-862-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1713 FORT JESSE RD STE D",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616235",
            "telephone_number": "309-862-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KALEB",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-30",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038013751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Williams, RN
• Christopher Williams, RP.H
• Khadijah Andrea Williams
• Stacey Danielle Williamson
• Wilma McLaughlin (Wilma McLaughlin Counseling & Mediation)
• Suzanne E. Wilton, A.P.N.
• Allison June Wingate, COTA/L
• Heather Winquist, NP
• Herbert Wiser, MD
• Emily Wolf, CST

• Chiropractor in Normal, IL
• Providers in Normal, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.