Healthcare Provider Details

I. General information

NPI: 1528237120
Provider Name (Legal Business Name): HUBERT ERVIN WILLIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 W TOWNLINE RD STE 200
VERNON HILLS IL
60061-4334
US

IV. Provider business mailing address

731S IL ROUTE 21 140
GURNEE IL
60031-3812
US

V. Phone/Fax

Practice location:
  • Phone: 224-207-4060
  • Fax: 630-701-1007
Mailing address:
  • Phone: 847-680-9200
  • Fax: 847-680-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038010448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: