Provider Demographics
NPI:1043425622
Name:MARSHALL M. WILLIS D.C., P.C.
Entity Type:Organization
Organization Name:MARSHALL M. WILLIS D.C., P.C.
Other - Org Name:MOUNTAIN HIGH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-535-6421
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:OVERGAARD
Mailing Address - State:AZ
Mailing Address - Zip Code:85933-0340
Mailing Address - Country:US
Mailing Address - Phone:928-535-6421
Mailing Address - Fax:928-535-6287
Practice Address - Street 1:2947 HWY 260
Practice Address - Street 2:3
Practice Address - City:OVERGAARD
Practice Address - State:AZ
Practice Address - Zip Code:85933
Practice Address - Country:US
Practice Address - Phone:928-535-6421
Practice Address - Fax:928-535-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty