Active NPI
Jay Ronald Willis, DC
- Chiropractor
- Mesa, AZ
National Provider Identifier
1942491733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2036
- Practice address
- 436 W 6TH St
Mesa, AZ 85201-4905 - Phone
- (480) 964-5455
- Fax
- (480) 964-5455
- NPI assigned
- Aug 6, 2007
- Last updated
- Aug 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2036 | AZ | Primary |
Addresses
Primary practice location
436 W 6TH St
Mesa, AZ 85201-4905
Mailing address
436 W 6TH St
Mesa, AZ 85201-4905
Phone (480) 964-5455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2036 | AZ | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186358400000",
"number": "1942491733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "436 W 6TH ST",
"city": "MESA",
"state": "AZ",
"postal_code": "852014905",
"telephone_number": "480-964-5455",
"fax_number": "480-964-5455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "436 W 6TH ST",
"city": "MESA",
"state": "AZ",
"postal_code": "852014905",
"telephone_number": "480-964-5455",
"fax_number": "480-964-5455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JAY",
"middle_name": "RONALD",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-06",
"last_updated": "2007-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AZ",
"license": "2036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.