MEDICARE: DR. STEVEN MATHIAS WILLIS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	CH0003581	FL

General Provider Information

NPI Number	:	1275561623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN MATHIAS WILLIS DC

Provider Business Mailing Address
First Line	:	1911 BUFORD BLVD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4466
Country	:	US
Telephone Number	:	850-878-3999
Fax Number	:	850-942-4587

Provider Business Practice Location Address
First Line	:	1911 BUFORD BLVD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4466
Country	:	US
Telephone Number	:	850-878-3999
Fax Number	:	850-942-4587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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