MEDICARE: KAYLIE RAE WILCOX DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	38MC00796000	NJ

General Provider Information

NPI Number	:	1093421430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLIE RAE WILCOX DC

Provider Business Mailing Address
First Line	:	966 ALLEN AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55118-1312
Country	:	US
Telephone Number	:	920-229-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 WASHINGTON VALLEY RD STE 4
Second Line	:
City	:	MARTINSVILLE
State	:	NJ
Zip	:	08836-2026
Country	:	US
Telephone Number	:	908-547-0729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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Directions to “ KAYLIE RAE WILCOX DC” Practice Location

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