Vanessa Jaclyn Wilczak, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH9776 Issued in FL

Practice address

10550 Deerwood Park Blvd Ste 609a
Jacksonville, FL 32256-0596

Phone

(904) 513-3954

Fax

(904) 212-0223

NPI assigned

Sep 11, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20866/brand/1/csg/1/fhir/r4

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.

• East Coast Neuro LLC

  • Neurology Physician
  • Jacksonville, FL
  • NPI 1124424643

  FL

  Medicare reassignment NPD Authorized official
• Vjwdc, Inc

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1578223764

  FL

  Medicare reassignment
• Cory McCormick, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jacksonville, FL
  • NPI 1043069115
  NPD

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

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1366775124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4831 FLORIDA CLUB CIR APT 2203",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161088",
            "telephone_number": "904-264-0400",
            "fax_number": "904-264-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10550 DEERWOOD PARK BLVD STE 609A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560596",
            "telephone_number": "904-513-3954",
            "fax_number": "904-212-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCZAK",
        "first_name": "VANESSA",
        "middle_name": "JACLYN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-11",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X011698",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2009008265",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennell Wilcox, COTA
• Kenyannya Wilcox
• Tracy Nicole Wilcox, PTA, LAT, ATC
• Victoria Garten Wilcox, LMHC
• Jerry Elliott Wilcoxon, MACCCSLP
• Steven Edward Wildasin, CRNA
• Nicholas Emil Wilde, MD
• Rebekah Leah Wildenberg
• Alyson Gibson Wilder, PHARMD, BCPS
• Robert Edward Wilder Jr., M.DIV., M.ED.

• All providers in Jacksonville, FL
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.