Provider Demographics
NPI:1275765448
Name:WILLIS, JOSEPH RAY (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RAY
Last Name:WILLIS
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 1:3124 RUTLEDGE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8053
Mailing Address - Country:US
Mailing Address - Phone:843-665-6777
Mailing Address - Fax:843-665-6677
Practice Address - Street 1:1501 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3141
Practice Address - Country:US
Practice Address - Phone:843-665-6777
Practice Address - Fax:843-665-6677
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3487OtherSC LISC