=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245352780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILL CHIROPRACTIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 556 WALMART DR
-----------------------------------------------------
City | SULLIVAN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63080-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-860-4455
-----------------------------------------------------
Fax | 573-860-4456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 556 WALMART DR
-----------------------------------------------------
City | SULLIVAN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63080-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-860-4455
-----------------------------------------------------
Fax | 573-860-4456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWENER
-----------------------------------------------------
Name | DR. WILLIAM LEE HILL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 573-860-4455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CE006261
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------