Provider Demographics
NPI:1306850193
Name:WILLS, THOMAS CAMERON (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CAMERON
Last Name:WILLS
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 1:4424 WILD THICKET LN
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7436
Mailing Address - Country:US
Mailing Address - Phone:843-225-7746
Mailing Address - Fax:843-225-7749
Practice Address - Street 1:8626 DORCHESTER RD
Practice Address - Street 2:101
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7328
Practice Address - Country:US
Practice Address - Phone:843-225-7746
Practice Address - Fax:843-225-7749
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2491111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2491 GCH462Medicaid
SCCH2491 GCH462Medicaid