Provider Demographics
NPI:1164867818
Name:JEFFREY B WILLES D C INC
Entity Type:Organization
Organization Name:JEFFREY B WILLES D C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-235-7804
Mailing Address - Street 1:664 14TH ST E
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-2569
Mailing Address - Country:US
Mailing Address - Phone:775-289-6800
Mailing Address - Fax:775-289-2579
Practice Address - Street 1:664 14TH ST E
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2569
Practice Address - Country:US
Practice Address - Phone:775-289-6800
Practice Address - Fax:775-289-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-565111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVDC565BMedicare PIN