Provider Demographics
NPI:1023021755
Name:WILLIAMS, RYAN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:WILLIAMS
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 1:152 PEDERNALES DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-9550
Mailing Address - Country:US
Mailing Address - Phone:919-740-7725
Mailing Address - Fax:
Practice Address - Street 1:27 ANNETTE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8045
Practice Address - Country:US
Practice Address - Phone:919-989-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902113Medicaid
NCV06963Medicare UPIN
NC2458216Medicare ID - Type Unspecified