Healthcare Provider Details

I. General information

NPI: 1386670735
Provider Name (Legal Business Name): WILLS FAMILY CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH ST
ORTONVILLE MI
48462-8530
US

IV. Provider business mailing address

PO BOX 309
ORTONVILLE MI
48462-0309
US

V. Phone/Fax

Practice location:
  • Phone: 248-831-1050
  • Fax: 248-831-1052
Mailing address:
  • Phone: 248-831-1050
  • Fax: 248-831-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008929
License Number StateMI

VIII. Authorized Official

Name: DR. HEATHER SUE WILLS
Title or Position: VICE PRESIDENT
Credential: D.C.
Phone: 248-831-1050