Provider Demographics
NPI:1962779769
Name:WILLIS CHIRO MED OF FLORENCE LLC
Entity type:Organization
Organization Name:WILLIS CHIRO MED OF FLORENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-665-6777
Mailing Address - Street 1:1501 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3141
Mailing Address - Country:US
Mailing Address - Phone:843-665-6777
Mailing Address - Fax:843-665-6677
Practice Address - Street 1:1501 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3141
Practice Address - Country:US
Practice Address - Phone:843-665-6777
Practice Address - Fax:843-665-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3487261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center