Provider Demographics
NPI:1467495150
Name:WILLIX, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:WILLIX
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:PO BOX 26 725 ROUTE 57
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886
Mailing Address - Country:US
Mailing Address - Phone:908-454-2666
Mailing Address - Fax:908-454-3315
Practice Address - Street 1:725 ROUTE 57
Practice Address - Street 2:
Practice Address - City:STEWARTSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08886-2100
Practice Address - Country:US
Practice Address - Phone:908-454-2666
Practice Address - Fax:908-454-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU70314Medicare UPIN
NJ009383Medicare ID - Type Unspecified