Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 01-05450 | KS |
NPI | 1003187790 |
---|---|
Provider Name | Jeremy Will |
First Address | Salina, KS 67401-6360 |
Second Address | Salina, KS 67401-6360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2012 |
Last Update Date | 26/01/2012 |