MEDICARE: DR. HUBERT ERVIN WILLIS D.C.

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	111N00000X	Chiropractor	038010448	IL

General Provider Information

NPI Number	:	1528237120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUBERT ERVIN WILLIS D.C.

Provider Business Mailing Address
First Line	:	731S IL ROUTE 21 140
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-3812
Country	:	US
Telephone Number	:	847-680-9200
Fax Number	:	847-680-9205

Provider Business Practice Location Address
First Line	:	281 W TOWNLINE RD STE 200
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-4334
Country	:	US
Telephone Number	:	224-207-4060
Fax Number	:	630-701-1007

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

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	11/11/2015

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