Provider Demographics
NPI:1730245622
Name:WILLIS S MUNCEY P S
Entity type:Organization
Organization Name:WILLIS S MUNCEY P S
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUNCEY
Authorized Official - Suffix:VI
Authorized Official - Credentials:DC
Authorized Official - Phone:509-467-7991
Mailing Address - Street 1:3017 E FRANCIS
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-2435
Mailing Address - Country:US
Mailing Address - Phone:509-467-7991
Mailing Address - Fax:509-467-4834
Practice Address - Street 1:3017 E FRANCIS
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-2435
Practice Address - Country:US
Practice Address - Phone:509-467-7991
Practice Address - Fax:509-467-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA71606OtherLABOR & INDUST
U11503Medicare UPIN
WAGAB36783Medicare PIN
WAGAB36782Medicare PIN