Provider Demographics
NPI:1497902613
Name:WILLEN, DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:WILLEN
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 1:1 SPLIT RAIL CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-3248
Mailing Address - Country:US
Mailing Address - Phone:908-730-5917
Mailing Address - Fax:866-371-3782
Practice Address - Street 1:1 SPLIT RAIL CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-3248
Practice Address - Country:US
Practice Address - Phone:908-730-5917
Practice Address - Fax:866-371-3782
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00667400111N00000X
NYNY 009410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor