Provider Demographics
NPI:1841227048
Name:WILLS, STACY FAYE (DC)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:FAYE
Last Name:WILLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 E LIMERICK RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-9610
Mailing Address - Country:US
Mailing Address - Phone:815-751-8254
Mailing Address - Fax:
Practice Address - Street 1:102 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-8926
Practice Address - Country:US
Practice Address - Phone:815-562-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400170301Medicare PIN