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General NPI Number Information
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NPI Number | 1285958942
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Entity Type | Organization
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Legal Business Name | S. GRANT WILLIS, D.C.
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 8140 PICTON WAY SUITE 103
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City | TRINITY
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State | FL
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Zip | 34655-1792
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Country | US
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Telephone | 727-753-9788
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Fax | 727-375-9720
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Provider Business Mailing Address
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Address Line | 8140 PICTON WAY SUITE 103
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City | TRINITY
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State | FL
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Zip | 34655-1792
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Country | US
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Telephone | 727-753-9788
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Fax | 727-375-9720
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN G WILLIS
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Credential | D.C.
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Telephone | 727-753-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH9385
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License Number State | FL
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