Provider Demographics
NPI:1174855787
Name:WILLEMSE, MICHAEL P (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:WILLEMSE
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 1:2 OLD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5803
Mailing Address - Country:US
Mailing Address - Phone:908-447-7009
Mailing Address - Fax:
Practice Address - Street 1:2 OLD CHURCH RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5803
Practice Address - Country:US
Practice Address - Phone:908-447-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ000000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX013357OtherNY LICENSE
NJ38MC00689200OtherNEW JERSEY LICENSE