Provider Demographics
NPI:1083668099
Name:WILLIAMS CHIRO MED INC
Entity Type:Organization
Organization Name:WILLIAMS CHIRO MED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:208-344-1851
Mailing Address - Street 1:1961 BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-344-1851
Mailing Address - Fax:208-344-3245
Practice Address - Street 1:1961 BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-344-1851
Practice Address - Fax:208-344-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U47681Medicare UPIN
ID1673249Medicare ID - Type Unspecified