Provider Demographics
NPI:1568507325
Name:WILLIS, DANIEL WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WADE
Last Name:WILLIS
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 1:5600 ARROYO AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422
Mailing Address - Country:US
Mailing Address - Phone:806-466-7240
Mailing Address - Fax:
Practice Address - Street 1:3534 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-2532
Practice Address - Country:US
Practice Address - Phone:805-462-2595
Practice Address - Fax:805-462-2595
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor