Provider Demographics
NPI:1154757516
Name:DOUG WILLEMS D.C., P.C.
Entity type:Organization
Organization Name:DOUG WILLEMS D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESTIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLEMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-475-6427
Mailing Address - Street 1:242 SW 4TH ST
Mailing Address - Street 2:STE. A
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1364
Mailing Address - Country:US
Mailing Address - Phone:541-475-6472
Mailing Address - Fax:547-475-7723
Practice Address - Street 1:242 SW 4TH ST
Practice Address - Street 2:STE. A
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1364
Practice Address - Country:US
Practice Address - Phone:541-475-6472
Practice Address - Fax:547-475-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty