Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH13251 | FL |
NPI | 1003415324 |
---|---|
Provider Name | Dr. William Philip Willis |
First Address | Orange Park, FL 32073-4527 |
Second Address | Orange Park, FL 32073-4527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2020 |
Last Update Date | 19/10/2020 |