Provider Demographics
NPI:1083756407
Name:WILLIAMS, CAROLYN DAVIS (RPH,DC,CCSP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DAVIS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RPH,DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 BINZ ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7813
Mailing Address - Country:US
Mailing Address - Phone:713-529-6760
Mailing Address - Fax:713-526-0655
Practice Address - Street 1:2408 WHEELER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-5250
Practice Address - Country:US
Practice Address - Phone:713-529-6760
Practice Address - Fax:713-526-0655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5023111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC603350Medicaid
TXT85085Medicare UPIN
TX603050Medicare ID - Type Unspecified