Provider Demographics
NPI:1558625418
Name:WILLE, CASEY M (DC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:WILLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:M
Other - Last Name:MAUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3507 BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1319
Mailing Address - Country:US
Mailing Address - Phone:804-526-7125
Mailing Address - Fax:
Practice Address - Street 1:3507 BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1319
Practice Address - Country:US
Practice Address - Phone:804-526-7125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor