Provider Demographics
NPI:1568592715
Name:WILLS, BRETT (DO)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:WILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HOUSE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2308
Mailing Address - Country:US
Mailing Address - Phone:717-388-4334
Mailing Address - Fax:
Practice Address - Street 1:13044 BUSTLETON AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19116-1602
Practice Address - Country:US
Practice Address - Phone:215-262-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015770208D00000X
PADC005418L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No111N00000XChiropractic ProvidersChiropractor