Provider Demographics
NPI:1104033638
Name:WILLETTS, VANESSA LYNNE (DC)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LYNNE
Last Name:WILLETTS
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 1:5401 S HYDE PARK BLVD
Mailing Address - Street 2:APT. #704
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5829
Mailing Address - Country:US
Mailing Address - Phone:773-558-6966
Mailing Address - Fax:
Practice Address - Street 1:5307 S HYDE PARK BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5728
Practice Address - Country:US
Practice Address - Phone:773-558-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor