Provider Demographics
NPI:1124373311
Name:WILLIAMS CHIROPRACTIC
Entity Type:Organization
Organization Name:WILLIAMS CHIROPRACTIC
Other - Org Name:PURE HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-255-4992
Mailing Address - Street 1:518 B SE WASHINGTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-213-0550
Mailing Address - Fax:877-518-0435
Practice Address - Street 1:518 SE WASHINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8236
Practice Address - Country:US
Practice Address - Phone:918-213-0550
Practice Address - Fax:877-518-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty