Justin Wayne Willis, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

12993 Issued in FL

Practice address

225 N Causeway
New Smyrna Beach, FL 32169-5239

Phone

(386) 424-9977

Fax

(386) 423-3899

NPI assigned

Dec 4, 2019

Last updated

Dec 4, 2019By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlantic Wellness CenterGroup PAC ID 7618070418, 4 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.

• Atlantic Wellness Center

  • Nutrition Chiropractor
  • New Smyrna Beach, FL
  • NPI 1245335264
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575417600000",
    "number": "1699312173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SEMINOLE AVE",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321768129",
            "telephone_number": "305-491-4171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N CAUSEWAY",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321695239",
            "telephone_number": "386-424-9977",
            "fax_number": "386-423-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JUSTIN",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-04",
        "last_updated": "2019-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "12993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "atlanticwellness@cfl.rr.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mail",
            "address_1": "225 N Causeway",
            "city": "New Smyrna Beach",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321695239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Calvin Williams
• Christine Lundberg Williams, M.D.
• Jennifer Lee Williams, DNP, FNP-C
• Robert Williams, M.D.
• Wesley Williams, DC
• Niloufar Wilson, MD
• Tara Beth Wilson, M.D.
• Wing Cardiology and Health LLC
• Shelby Robert Wise, DO
• Denise Wisely, DO

• Chiropractor in New Smyrna Beach, FL
• Providers in New Smyrna Beach, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; 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.