Provider Demographics
NPI:1407030901
Name:ZUHIRA, WILL A (DC)
Entity Type:Individual
Prefix:DR
First Name:WILL
Middle Name:A
Last Name:ZUHIRA
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 1:944 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-3614
Mailing Address - Country:US
Mailing Address - Phone:815-410-4004
Mailing Address - Fax:815-410-4006
Practice Address - Street 1:944 4TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-3614
Practice Address - Country:US
Practice Address - Phone:815-410-4004
Practice Address - Fax:815-410-4006
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038010923Medicaid