Provider Demographics
NPI:1104853175
Name:WILLIAMS, ANDREW OTIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:OTIS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9381 E STOCKTON BLVD
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5068
Mailing Address - Country:US
Mailing Address - Phone:916-686-6062
Mailing Address - Fax:916-686-6144
Practice Address - Street 1:9381 E STOCKTON BLVD
Practice Address - Street 2:SUITE # 130
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5068
Practice Address - Country:US
Practice Address - Phone:916-686-6062
Practice Address - Fax:916-686-6144
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor