Provider Demographics
NPI:1356310577
Name:WILLIS, JOHN CURTIS (CH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CURTIS
Last Name:WILLIS
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-963-0395
Mailing Address - Fax:276-964-2225
Practice Address - Street 1:305 ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-963-0395
Practice Address - Fax:276-964-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1300519OtherUMWA UNITED MINE WORKERS
VA007315OtherANTHEM BLUE CROSS BLUE SH
VA4669783OtherAETNA