Provider Demographics
NPI:1528237120
Name:WILLIS, HUBERT ERVIN (DC)
Entity type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:ERVIN
Last Name:WILLIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:731S IL ROUTE 21 140
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3812
Mailing Address - Country:US
Mailing Address - Phone:847-680-9200
Mailing Address - Fax:847-680-9205
Practice Address - Street 1:281 W TOWNLINE RD STE 200
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-4334
Practice Address - Country:US
Practice Address - Phone:224-207-4060
Practice Address - Fax:630-701-1007
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor