DR. DERRICK D WALLERY D.C.
NPI 1437311701
Chiropractor in Chicago, IL

Q: What is Derrick Wallery's NPI number?

The NPI number for Derrick Wallery is 1437311701. It was assigned to this individual provider in the NPPES registry on June 27, 2008.

Q: What is Derrick Wallery's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Q: When was this NPI record last updated?

The NPPES record for Derrick Wallery was last updated on June 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 27, 2008

4176 W MONTROSE AVE, CHICAGO, IL 60641(773) 283-3131(773) 283-3610 Get Directions Write a Review

NPPES record last updated: June 13, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

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About Dr. Derrick D Wallery D.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DERRICK D WALLERY D.C. (NPI 1437311701) is an individual chiropractor in Chicago, Illinois, licensed in Illinois (038008088) and active in the NPI registry since June 2008. He is a graduate of Northwestern College Of Chiropractic (1992).

NPPES Registry Identity

NPI1437311701

Entity TypeIndividualMale

Primary Taxonomy111N00000X

Provider Legal NameDR. DERRICK D WALLERYCredential: D.C.

Location Address4176 W MONTROSE AVEChicago, IL 60641-2161

Mailing AddressPo Box 937Dixon, IL 61021-0937 · (738) 440-1237

Phone(773) 283-3131

Fax(773) 283-3610

Sole ProprietorNo

Medical School CMSNorthwestern College Of ChiropracticGraduated 1992

Enumeration DateJune 27, 2008

Last NPPES UpdateJune 13, 2024

NPPES CertifiedJune 13, 2024

✔ NPI 1437311701 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers

Taxonomy Code111N00000X

Licenses✔ Licensed in IL · 038008088✔ Licensed in MI · 2301401202

Definition

A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

4176 W MONTROSE AVE, Chicago, IL 60641

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Derrick D Wallery D.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9335154269

PECOS Enrollment IDI20260819000082

Medicare Billing Reassignment

Medicare enrollment records show Derrick Wallery reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Chicago Anti Aging Institute Sc

29 mi

Neuromusculoskeletal Medicine, Sports Medicine

16622 W 159TH ST STE 500
Lockport, IL 60441

Reassigned Medicare billing, Illinois enrollment
4 clinicians in this Medicare group

NPI 1003376245 (815) 838-7746

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

VITAL LABS INC

Clinical Medical Laboratory

4176 W MONTROSE AVE
CHICAGO, IL 60641

Cook County (773) 654-3069

DR. LORENA RAMIREZ D.C.

Chiropractor

4176 W MONTROSE AVE
CHICAGO, IL 60641

Cook County (773) 283-3131

DR. FERNANDO PEREZ D.C.

Chiropractor

4176 W MONTROSE AVE
CHICAGO, IL 60641

Cook County (773) 283-3131

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derrick Wallery's NPI number?

The NPI number for Derrick Wallery is 1437311701. It was assigned to this individual provider in the NPPES registry on June 27, 2008.

Where is Derrick Wallery located?

Derrick Wallery practices at 4176 W Montrose Ave, Chicago, IL 60641. The listed phone number is (773) 283-3131.

What is Derrick Wallery's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Derrick Wallery enrolled in Medicare?

Yes. Derrick Wallery is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Derrick Wallery's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Derrick Wallery reassigns Medicare benefits to Chicago Anti Aging Institute Sc (Lockport, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Derrick Wallery's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Derrick Wallery was last updated on June 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.