Provider Demographics
NPI:1124638143
Name:WILLS, MADISON J (DC)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:J
Last Name:WILLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9196 W EMERALD ST STE 120
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8003
Mailing Address - Country:US
Mailing Address - Phone:208-990-7010
Mailing Address - Fax:
Practice Address - Street 1:9196 W EMERALD ST STE 120
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8003
Practice Address - Country:US
Practice Address - Phone:208-990-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor