Provider Demographics
NPI:1386670735
Name:WILLS FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:WILLS FAMILY CHIROPRACTIC, INC.
Other - Org Name:DR. JASON C WILLS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-831-1050
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-0309
Mailing Address - Country:US
Mailing Address - Phone:248-831-1050
Mailing Address - Fax:248-831-1052
Practice Address - Street 1:101 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8530
Practice Address - Country:US
Practice Address - Phone:248-831-1050
Practice Address - Fax:248-831-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1659347094Medicare UPIN
MI1912973355Medicare UPIN