Provider Demographics
NPI:1073663787
Name:WILLING, DAVID R (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:WILLING
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 1:237 ROGUE RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5445
Mailing Address - Country:US
Mailing Address - Phone:541-476-2112
Mailing Address - Fax:541-476-6294
Practice Address - Street 1:237 ROGUE RIVER HWY
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5445
Practice Address - Country:US
Practice Address - Phone:541-476-2112
Practice Address - Fax:541-476-6294
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGDXWMedicare UPIN