Provider Demographics
NPI:1598048506
Name:WILLS CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:WILLS CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-243-3934
Mailing Address - Street 1:2625 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2916
Mailing Address - Country:US
Mailing Address - Phone:573-243-3934
Mailing Address - Fax:573-243-3935
Practice Address - Street 1:2625 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2916
Practice Address - Country:US
Practice Address - Phone:573-243-3934
Practice Address - Fax:573-243-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4275261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000030750Medicare UPIN