Individual
DR. MATTHEW DIRK WILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
141 VINEGAR HILL ROAD, WINSTON SALEM, NC 27104
(336) 448-1894
(336) 448-1895
Mailing address
141 VINEGAR HILL RD, WINSTON SALEM, NC 27104-5069
(336) 448-1894
(336) 448-1895
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3904
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
086CJ
BLUE CROSS PTAN
NC
01
—
111N00000X
TAXONOMY
—
01
—
2451497B
MEDICARE GROUP PTAN
NC
01
—
2456085
MEDICARE PTAN
NC
05
—
5950449
—
NC
Enumeration date
08/26/2008
Last updated
01/30/2013
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