Provider Demographics
NPI:1295934883
Name:MCFADDEN, WILLIE L (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:L
Last Name:MCFADDEN
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 1:181 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2357
Mailing Address - Country:US
Mailing Address - Phone:586-954-2548
Mailing Address - Fax:
Practice Address - Street 1:181 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2357
Practice Address - Country:US
Practice Address - Phone:586-954-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor