Individual provider Active NPI

William Wilkerson III, D.C

  • Chiropractor
  • Leesville, LA
National Provider Identifier
1790874469
Registry record updated Dec 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1490 Issued in LA
Practice address
802 S 10TH St
Suite B
Leesville, LA 71446-4612
Phone
(337) 238-5338
Fax
(337) 238-5340
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC29021 CA
Chiropractor 111N00000X 1490 LA Primary

Addresses

Primary practice location

802 S 10TH St
Suite B
Leesville, LA 71446-4612

Mailing address

802 S 10TH St
Suite B
Leesville, LA 71446-4612
Phone (337) 238-5338

Other identifiers 1

IdentifierTypeStateIssuer
DC0290210OtherCABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090119000098 LA Practitioner - Chiropractic 2769479633 Practice locations: Leesville, LA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

802 S 10 St B
Leesville Family Chiropractic
Leesville, LA 71446-4612
Phone (337) 238-5338

802 S 10TH St
Suite B
Leesville, LA 71446-4612

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229472000000",
    "number": "1790874469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 S 10TH ST",
            "address_2": "SUITE B",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464612",
            "telephone_number": "337-238-5338",
            "fax_number": "337-238-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 S 10TH ST",
            "address_2": "SUITE B",
            "city": "LEESVILLE",
            "state": "LA",
            "postal_code": "714464612",
            "telephone_number": "337-238-5338",
            "fax_number": "337-238-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "WILLIAM",
        "name_suffix": "III",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2008-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC29021",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "LA",
            "license": "1490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "DC0290210",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; 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.