Nicole Willis, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIA-1268 Issued in ID

Practice address

1570 E Heritage Park St
Ste 175
Meridian, ID 83646-6445

Phone

(208) 322-4114

Fax

(208) 322-4115

NPI assigned

Jan 28, 2008

Last updated

Jan 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dawn Nicole Willis Other name

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Chiropractic

Education

Cleveland Chiropractic College - Kansas City, 2007

Medicare assignment

May accept Medicare assignment

Group practices

Willis Family Chiropractic, LLCGroup PAC ID 3678641719, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Willis Family Chiropractic, LLC

  • Chiropractor
  • Boise, ID
  • NPI 1114191137
  Medicare reassignment Care Compare group NPD Authorized official
• Walker Chiropractic Life Center, P.a.

  • Chiropractor
  • Boise, ID
  • NPI 1962672071
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580428800000",
    "number": "1093992539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 E HERITAGE PARK ST",
            "address_2": "STE 175",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466445",
            "telephone_number": "208-322-4114",
            "fax_number": "208-322-4115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 E HERITAGE PARK ST",
            "address_2": "STE 175",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466445",
            "telephone_number": "208-322-4114",
            "fax_number": "208-322-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "NICOLE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-28",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "1370103",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAWN",
            "last_name": "WILLIS",
            "middle_name": "NICOLE",
            "credential": "D.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tiffany Ann Williams, FNP-C
• Timothy P Williams, PT, DPT, SCS, CSCS
• Travis G Williams, DO
• Chad C Willis, D.C.
• Lauren Willis
• Taylor Lynne Willis, OTR/L
• Laura Kathleen Willoughby, M.S. CCC-SLP
• Scott Donald Willoughby, FNP-C
• Willow and Stone Counseling LLC
• Willow Tree Dental Group LLC

• Chiropractor in Meridian, ID
• Providers in Meridian, ID by specialty
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.