Provider Demographics
NPI:1003187790
Name:WILL, JEREMY (DC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-2817
Mailing Address - Country:US
Mailing Address - Phone:785-262-4344
Mailing Address - Fax:785-262-4346
Practice Address - Street 1:208 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2817
Practice Address - Country:US
Practice Address - Phone:785-262-4344
Practice Address - Fax:785-262-4346
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor