Provider Demographics
NPI:1063478980
Name:WILLIAMS, KIMBERLY FAYE (DC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KOSCIUSCO ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1400
Mailing Address - Country:US
Mailing Address - Phone:303-506-6495
Mailing Address - Fax:
Practice Address - Street 1:200 KOSCIUSCO ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1400
Practice Address - Country:US
Practice Address - Phone:303-506-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor