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General NPI Number Information
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NPI Number | 1780632422
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Entity Type | Individual
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Provider Name | RANDY JOE WILLIS D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 607 RAINBOW DR
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City | KANNAPOLIS
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State | NC
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Zip | 28081-4746
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Country | US
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Telephone | 704-652-1393
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Fax |
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Provider Business Mailing Address
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Address Line | 242 OAK AVE STE 155
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City | KANNAPOLIS
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State | NC
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Zip | 28081-4329
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Country | US
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Telephone | 980-330-1680
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3043
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License Number State | NC
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