Provider Demographics
NPI:1407950611
Name:WILLS, JAMES WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:WILLS
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 1:2625 EAST JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2916
Mailing Address - Country:US
Mailing Address - Phone:573-243-3934
Mailing Address - Fax:573-243-3935
Practice Address - Street 1:2625 EAST JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2916
Practice Address - Country:US
Practice Address - Phone:573-243-3934
Practice Address - Fax:573-243-3935
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
124696OtherHEALTHLINK
14182OtherBCBS
124696OtherHEALTHLINK