Justin Kyle Willis, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

9165 Issued in GA

Practice address

2829 Dallas St NW
Kennesaw, GA 30144-2705

Phone

(770) 429-0707

Fax

(770) 425-9020

NPI assigned

Aug 2, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Chiropractic

Education

Sherman College of Straight Chiropractic, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Willis Family Chiropractic, LLC

  • Chiropractor
  • Kennesaw, GA
  • NPI 1811442213

  GA

  Medicare reassignment
• Revive Wellness of Kennesaw LLC

  • General Practice Physician
  • Kennesaw, GA
  • NPI 1033049390
  NPD

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

{
    "created_epoch": "1375401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375401600000",
    "number": "1639501588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 DALLAS ST NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442705",
            "telephone_number": "770-429-0707",
            "fax_number": "770-425-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 DALLAS ST NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442705",
            "telephone_number": "770-429-0707",
            "fax_number": "770-425-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JUSTIN",
        "middle_name": "KYLE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-02",
        "last_updated": "2013-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "9165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anjali Williamson, DDS
• Stacey Willingham, M.D.
• Willis Chiropractic Center LLC
• Willis Family Chiropractic, LLC
• Amy Dee Willis, D.C.
• Nancy Kay Willis, D.C.
• William N Willis, D.C.
• Lori Brazell Wills, ED.S., CCC-SLP
• Ashley Wilson, PTA
• Bradley Neal Wilson, DC

• Chiropractor in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; 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.