Healthcare Provider Details

I. General information

NPI: 1407030901
Provider Name (Legal Business Name): WILL A ZUHIRA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 4TH ST
PERU IL
61354-3614
US

IV. Provider business mailing address

944 4TH ST
PERU IL
61354-3614
US

V. Phone/Fax

Practice location:
  • Phone: 815-410-4004
  • Fax: 815-410-4006
Mailing address:
  • Phone: 815-410-4004
  • Fax: 815-410-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010923
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: