Healthcare Provider Details

I. General information

NPI: 1164867818
Provider Name (Legal Business Name): JEFFREY B WILLES D C INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 14TH ST E
ELY NV
89301-2569
US

IV. Provider business mailing address

664 14TH ST E
ELY NV
89301-2569
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-6800
  • Fax: 775-289-2579
Mailing address:
  • Phone: 775-289-6800
  • Fax: 775-289-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberB-565
License Number StateNV

VIII. Authorized Official

Name: DR. JEFFREY B WILLES
Title or Position: PRESIDENT
Credential: D.C.
Phone: 775-235-7804