Healthcare Provider Details

I. General information

NPI: 1306885330
Provider Name (Legal Business Name): COLIN WILLS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 N SHORE RD
ABSECON NJ
08201-1328
US

IV. Provider business mailing address

624 N SHORE RD
ABSECON NJ
08201-1328
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-5766
  • Fax: 609-677-5767
Mailing address:
  • Phone: 609-677-5766
  • Fax: 609-677-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00569100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: