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General NPI Number Information
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NPI Number | 1083157002
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Entity Type | Organization
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Legal Business Name | PAUL J. WILLERT CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 813 W DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67213-4704
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Country | US
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Telephone | 316-440-4052
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Fax |
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Provider Business Mailing Address
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Address Line | 813 W DOUGLAS AVE
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City | WICHITA
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State | KS
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Zip | 67213-4704
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Country | US
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Telephone | 316-440-4052
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL JERALD WILLERT
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Credential | D.C.
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Telephone | 316-990-0143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4601
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License Number State | KS
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