DR. KRISTOPHER WYLLIS PETERSON (DC) – Chiropractor, NPI 1003862871

DR. KRISTOPHER WYLLIS PETERSON (DC) is a healthcare provider. based in Kenosha, Wisconsin. specializing in CHIROPRACTIC. They hold the professional credentials DC. They hold a License No. 3762012 (WI). The NPI Number for DR. KRISTOPHER WYLLIS PETERSON (DC) is 1003862871

Main info

Male
26 Years Of Experience
Accepts Medicare Assignment
Name
DR. KRISTOPHER WYLLIS PETERSON (DC)
NPI
1003862871
Phone
(262) 697-1363
Address
5703 75TH ST
Enumeration Date
25 May 2006
Last Update Date
8 July 2007

Doctor Profile

Medical School Name
PALMER COLLEGE CHIROPRACTIC - DAVENPORT
Secondary Phone
2626971363
Graduation Year
2000 (26 years ago)
PAC ID
6608890710
Group Practice PAC ID
6709800816
Professional Enrollment ID
I20060119000084
Address ID
WI531423603KE5703XSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

1,617 CHIROPRACTIC in WI

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Provider Addresses for DR. KRISTOPHER WYLLIS PETERSON (DC)

  • 75th Street, Sunnyside, Kenosha, Kenosha County, Wisconsin, 53143, United States

    KENOSHA, WI 531423603

    Phone: (262) 697-1363

    Fax: (262) 697-1388

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2006-01-19

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20060119000084IChiropracticWITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
98940Chiropractic manipulative treatment, 1-2 spinal regions83279$0
View full utilization report →

Insurance plans in this area (ZIP 53142)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6709800816View full group profile
NameSpecialtyState
C H I R O P R A C T I CWI

Reviews

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Frequently asked questions

Is there an official ID for DR. KRISTOPHER WYLLIS PETERSON (DC) in U.S. healthcare records?
The official identifier for DR. KRISTOPHER WYLLIS PETERSON (DC) is NPI 1003862871.
Active or inactive — what applies to DR. KRISTOPHER WYLLIS PETERSON (DC)?
You should see DR. KRISTOPHER WYLLIS PETERSON (DC) as active in CMS-hosted NPPES data.
What clinical focus is listed for DR. KRISTOPHER WYLLIS PETERSON (DC)?
At a glance, DR. KRISTOPHER WYLLIS PETERSON (DC) is tied to Chiropractor. Clinical services aligned with this taxonomy classification.
Is DR. KRISTOPHER WYLLIS PETERSON (DC) associated with Kenosha?
Public fields place DR. KRISTOPHER WYLLIS PETERSON (DC) around Kenosha, Wisconsin. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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