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General NPI Number Information
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NPI Number | 1376798934
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Entity Type | Individual
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Provider Name | WILLES KO D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 715 ASTOR LN SUITE 301
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City | WHEELING
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State | IL
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Zip | 60090
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Country | US
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Telephone | 630-254-0581
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Fax | 773-774-1372
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Provider Business Mailing Address
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Address Line | 715 ASTOR LN UNIT 301
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City | WHEELING
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State | IL
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Zip | 60090
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Country | US
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Telephone | 630-254-0581
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Fax | 224-588-9416
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 038010090
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License Number State | IL
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