Provider Demographics
NPI:1780001107
Name:WILLING FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:WILLING FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLING
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:423-499-0102
Mailing Address - Street 1:5959 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 527
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2285
Mailing Address - Country:US
Mailing Address - Phone:423-499-0102
Mailing Address - Fax:423-499-9857
Practice Address - Street 1:5959 SHALLOWFORD RD
Practice Address - Street 2:SUITE 527
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2285
Practice Address - Country:US
Practice Address - Phone:423-499-0102
Practice Address - Fax:423-499-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861405458OtherNPI FOR EVAN G. WILLING III