Provider Demographics
NPI:1063519247
Name:WILLEY, DONALD EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EUGENE
Last Name:WILLEY
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 1:1809 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3033
Mailing Address - Country:US
Mailing Address - Phone:559-445-3120
Mailing Address - Fax:559-432-3763
Practice Address - Street 1:1809 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3033
Practice Address - Country:US
Practice Address - Phone:559-445-3120
Practice Address - Fax:559-432-3763
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0125800Medicare ID - Type Unspecified