Provider Demographics
NPI:1114099629
Name:WILLIAMS, KURT S (DC)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:S
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:PO BOX 496
Mailing Address - Street 2:315 NORTH ELM
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801
Mailing Address - Country:US
Mailing Address - Phone:618-532-7600
Mailing Address - Fax:618-532-8667
Practice Address - Street 1:315 NORTH ELM
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-532-7600
Practice Address - Fax:618-532-8667
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
426286OtherHEALTHLINK
6119593OtherBCBS
350031038OtherPALMETTO
T38171Medicare UPIN
6119593OtherBCBS