Healthcare Provider Details

I. General information

NPI: 1730245622
Provider Name (Legal Business Name): WILLIS S MUNCEY P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 E FRANCIS STE 101
SPOKANE WA
99208-2435
US

IV. Provider business mailing address

3017 E FRANCIS STE 101
SPOKANE WA
99208-2435
US

V. Phone/Fax

Practice location:
  • Phone: 509-467-7991
  • Fax: 509-467-4834
Mailing address:
  • Phone: 509-467-7991
  • Fax: 509-467-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00002393
License Number StateWA

VIII. Authorized Official

Name: MR. WILLIS S MUNCEY VI
Title or Position: OWNER
Credential: DC
Phone: 509-467-7991