Provider Demographics
NPI:1619072634
Name:VILLEGAS, ISRAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:VILLEGAS
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 1:701 N GODDARD RD STE A
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-9036
Mailing Address - Country:US
Mailing Address - Phone:316-794-8410
Mailing Address - Fax:316-794-8466
Practice Address - Street 1:701 N GODDARD RD STE A
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-9036
Practice Address - Country:US
Practice Address - Phone:316-794-8410
Practice Address - Fax:316-794-8466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 01-04020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014211OtherBC/BS ID
KSKS2757OtherPCC ID
KSU05367Medicare UPIN