Provider Demographics
NPI:1376798934
Name:KO, WILLES (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLES
Middle Name:
Last Name:KO
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 1:715 ASTOR LN
Mailing Address - Street 2:UNIT 301
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:630-254-0581
Mailing Address - Fax:224-588-9416
Practice Address - Street 1:715 ASTOR LN
Practice Address - Street 2:SUITE 301
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:630-254-0581
Practice Address - Fax:773-774-1372
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010090111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation