Provider Demographics
NPI:1841244175
Name:WILLIS, CHRISTOPHER P (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:P
Last Name:WILLIS
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 1:1431 RIVERSIDE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5995
Mailing Address - Country:US
Mailing Address - Phone:770-513-0111
Mailing Address - Fax:770-513-3731
Practice Address - Street 1:1431 RIVERSIDE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5946
Practice Address - Country:US
Practice Address - Phone:770-513-0111
Practice Address - Fax:770-513-3731
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJNQMedicare ID - Type Unspecified
GAU43499Medicare UPIN