Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 565B | NV |
N | 111NS0005X | Chiropractic Sports Physician | 4182 | NV |
NPI | 1356442651 |
---|---|
Provider Name | Dr. Jeffrey B Willes |
First Address | Ely, NV 89301 |
Second Address | Ely, NV 89301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 13/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC565B | (02) | NV |