Jennifer Susan Wilson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

9991 Issued in TX

Practice address

7060 Phelan Blvd
Suite 101
Beaumont, TX 77706-6168

Phone

(409) 866-8661

Fax

(409) 866-4371

NPI assigned

Jan 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2004

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Wilson Chiropractic

  • Chiropractor
  • Beaumont, TX
  • NPI 1740493840
  NPD (past)

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427109750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7060 PHELAN BLVD",
            "address_2": "SUITE 101",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777066168",
            "telephone_number": "409-866-8661",
            "fax_number": "409-866-4371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7060 PHELAN BLVD",
            "address_2": "SUITE 101",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777066168",
            "telephone_number": "409-866-8661",
            "fax_number": "409-866-4371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JENNIFER",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "9991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "9991",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "8K7171",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason J Willis, DPM
• Wilson Chiropractic
• Caleb T Wilson
• Cameron Dawn Wilson
• Hazel Wilson
• Larissa Denise Wilson, LVN
• Melva Wilson
• Sandra Kathryn Wilson, LCSW, ASOTP
• Darlene Wimbley
• Jana Windle, LPC

• Chiropractor in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.