Healthcare Provider Details

I. General information

NPI: 1205939014
Provider Name (Legal Business Name): JEFFERY JAMES WILSON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 MONROE ST
GALESBURG IL
61401-2542
US

IV. Provider business mailing address

1128 MONROE ST
GALESBURG IL
61401-2542
US

V. Phone/Fax

Practice location:
  • Phone: 309-342-9147
  • Fax:
Mailing address:
  • Phone: 309-342-9147
  • Fax: 309-343-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: