Provider Demographics
NPI:1386683027
Name:HILLIARD, W LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:LEE
Last Name:HILLIARD
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 1:112 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6305
Mailing Address - Country:US
Mailing Address - Phone:505-356-6982
Mailing Address - Fax:505-356-3773
Practice Address - Street 1:112 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6305
Practice Address - Country:US
Practice Address - Phone:505-356-6982
Practice Address - Fax:505-356-3773
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor