MEDICARE: DR. KILEY JEAN WILLIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	01-05455	KS

General Provider Information

NPI Number	:	1245502509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KILEY JEAN WILLIS D.C.

Provider Business Mailing Address
First Line	:	30 W SHERMAN ST
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-5428
Country	:	US
Telephone Number	:	620-663-5632
Fax Number	:	620-663-4986

Provider Business Practice Location Address
First Line	:	30 W SHERMAN ST
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-5428
Country	:	US
Telephone Number	:	620-663-5632
Fax Number	:	620-663-4986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	08/02/2012

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