Provider Demographics
NPI:1255332342
Name:FALLIS, WILLIAM KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEVIN
Last Name:FALLIS
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 1:115 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1425
Mailing Address - Country:US
Mailing Address - Phone:618-667-7003
Mailing Address - Fax:
Practice Address - Street 1:115 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-1425
Practice Address - Country:US
Practice Address - Phone:618-667-7003
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2660OtherBLUE CROSS BLUE SHIELD
IL6082088OtherBULE CROSS BLUE SHEILD
IL4407353OtherUNITED HEALTH CARE
T38884Medicare UPIN
IL6082088OtherBULE CROSS BLUE SHEILD