Provider Demographics
NPI:1023216710
Name:WILLETT, LUKE A (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:A
Last Name:WILLETT
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 1:3555 N. COLE RD.
Mailing Address - Street 2:APT. #303
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-0751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3040 N FIVE MILE RD
Practice Address - Street 2:SUITE C
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5234
Practice Address - Country:US
Practice Address - Phone:208-321-8484
Practice Address - Fax:208-321-5084
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor