Provider Demographics
NPI:1659347094
Name:WILLS, JASON C (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:WILLS
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:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-0309
Mailing Address - Country:US
Mailing Address - Phone:248-831-1050
Mailing Address - Fax:248-831-1052
Practice Address - Street 1:101 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8530
Practice Address - Country:US
Practice Address - Phone:248-831-1050
Practice Address - Fax:248-831-1052
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-F3-2472-0Medicare UPIN