Provider Demographics
NPI:1174583991
Name:MUNCEY, WILLIS S (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:S
Last Name:MUNCEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 E FRANCIS
Mailing Address - Street 2:SUITE 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:SUITE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-467-7991
Practice Address - Fax:509-467-4834
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA71606OtherLABOR & INDUSTRIES
WAAB36783Medicaid
U11503Medicare UPIN
WAAB36783Medicaid