Provider Demographics
NPI:1003598053
Name:WILLIS, HAYLEY (DC)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1846
Mailing Address - Country:US
Mailing Address - Phone:859-239-0022
Mailing Address - Fax:859-239-0044
Practice Address - Street 1:434 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1846
Practice Address - Country:US
Practice Address - Phone:859-239-0022
Practice Address - Fax:859-239-0044
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY286376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor