Provider Demographics
NPI:1972720183
Name:WILLNER, PHILIP M (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:WILLNER
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 1:10784 RAINRIBBON RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5656
Mailing Address - Country:US
Mailing Address - Phone:720-283-8006
Mailing Address - Fax:720-283-8006
Practice Address - Street 1:7261 S BROADWAY STE 101B
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-8017
Practice Address - Country:US
Practice Address - Phone:720-283-8006
Practice Address - Fax:720-283-8006
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor