Healthcare Provider Details

I. General information

NPI: 1306776380
Provider Name (Legal Business Name): WILKYWAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4429 NELSON RD
LAKE CHARLES LA
70605-4135
US

IV. Provider business mailing address

4429 NELSON RD
LAKE CHARLES LA
70605-4135
US

V. Phone/Fax

Practice location:
  • Phone: 512-897-3925
  • Fax:
Mailing address:
  • Phone: 512-897-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. COLE WILKINSON
Title or Position: SOLE MEMBER
Credential: DC
Phone: 512-897-3925