Provider Demographics
NPI:1669486221
Name:WILLEMS, DOUG S (DC)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:S
Last Name:WILLEMS
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 1:2041 NE WILLIAMSON CT STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3941
Mailing Address - Country:US
Mailing Address - Phone:541-389-7660
Mailing Address - Fax:541-389-9204
Practice Address - Street 1:2041 NE WILLIAMSON CT STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3941
Practice Address - Country:US
Practice Address - Phone:541-389-7660
Practice Address - Fax:541-389-9204
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104044Medicare ID - Type Unspecified
ORT100531Medicare UPIN