Provider Demographics
NPI:1093421430
Name:WILCOX, KAYLIE RAE (DC)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:RAE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1312
Mailing Address - Country:US
Mailing Address - Phone:920-229-8131
Mailing Address - Fax:
Practice Address - Street 1:1910 WASHINGTON VALLEY RD STE 4
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08836-2026
Practice Address - Country:US
Practice Address - Phone:908-547-0729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00796000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor