Provider Demographics
NPI:1083157002
Name:PAUL J. WILLERT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PAUL J. WILLERT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JERALD
Authorized Official - Last Name:WILLERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-990-0143
Mailing Address - Street 1:813 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4704
Mailing Address - Country:US
Mailing Address - Phone:316-440-4052
Mailing Address - Fax:
Practice Address - Street 1:813 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4704
Practice Address - Country:US
Practice Address - Phone:316-440-4052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty