Provider Demographics
NPI:1881004240
Name:WILLS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WILLS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-562-5333
Mailing Address - Street 1:102 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-8926
Mailing Address - Country:US
Mailing Address - Phone:815-562-5333
Mailing Address - Fax:815-562-5833
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:815-562-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100170285Medicare PIN