Provider Demographics
NPI:1104160795
Name:WILLAT, DAVID FREDERICK (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FREDERICK
Last Name:WILLAT
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 1:5742 OWLS NEST DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4350
Mailing Address - Country:US
Mailing Address - Phone:707-537-1036
Mailing Address - Fax:707-537-1261
Practice Address - Street 1:5742 OWLS NEST DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4350
Practice Address - Country:US
Practice Address - Phone:707-537-1036
Practice Address - Fax:707-537-1261
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16088111NI0013X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NX0800XChiropractic ProvidersChiropractorOrthopedic