Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0003581 | FL |
NPI | 1275561623 |
---|---|
Provider Name | Dr. Steven Mathias Willis |
First Address | Tallahassee, FL 32308-4466 |
Second Address | Tallahassee, FL 32308-4466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T55898 | (02) | FL |