NPIMap

Organization Active NPI

J R Willis DC PC

  • Chiropractor
  • Princeton, WV
National Provider Identifier
1710974779
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
589 Issued in WV
Legal business name
J R WILLIS DC PC
Doing business as
Willis Chiropractic
Practice address
1512 N Walker St
Princeton, WV 24740-2639
Phone
(304) 487-8985
Fax
(304) 425-1680
NPI assigned
Oct 4, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Lee R Willis, DCNPI 1053498964
Title
Chiropractor
Phone
(276) 228-3883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 589 WV Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 0104001278 VA

Addresses

Primary practice location

1512 N Walker St
Princeton, WV 24740-2639

Mailing address

570 E Main St
Wytheville, VA 24382-2033
Phone (276) 228-3883

Other identifiers 1

IdentifierTypeStateIssuer
0131755000MedicaidWV

Other names 1

  • Willis Chiropractic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
J R Willis DC PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710974779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 E MAIN ST",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243822033",
            "telephone_number": "276-228-3883",
            "fax_number": "276-223-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 N WALKER ST",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402639",
            "telephone_number": "304-487-8985",
            "fax_number": "304-425-1680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J R WILLIS DC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "276-228-3883",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WV",
            "license": "589",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104001278",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0131755000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willis Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.