MEDICARE: CASEY M WILLE 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	111N00000X	Chiropractor	0104556972	VA

General Provider Information

NPI Number	:	1558625418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY M WILLE DC

Provider Business Mailing Address
First Line	:	3507 BOULEVARD
Second Line	:	SUITE A
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1319
Country	:	US
Telephone Number	:	804-526-7125
Fax Number	:

Provider Business Practice Location Address
First Line	:	3507 BOULEVARD
Second Line	:	SUITE A
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1319
Country	:	US
Telephone Number	:	804-526-7125
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	12/09/2014

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