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General NPI Number Information
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NPI Number | 1770875411
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Entity Type | Organization
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Legal Business Name | WILLIS WELLNESS LLC
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 3730 FRANKFORT AVE #203
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City | LOUISVILLE
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State | KY
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Zip | 40207-2582
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Country | US
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Telephone | 502-409-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 219 NORBOURNE BLVD
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City | LOUISVILLE
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State | KY
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Zip | 40207-3922
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Country | US
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Telephone | 502-836-0303
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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. RICHARD TROY WILLIS
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Credential | DC
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Telephone | 502-836-0303
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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 | 4799
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License Number State | KY
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