Provider Demographics
NPI:1154463644
Name:WILLIAMS, CHARLES R (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
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 1:405 S BEELINE HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4800
Mailing Address - Country:US
Mailing Address - Phone:928-474-0442
Mailing Address - Fax:
Practice Address - Street 1:405 S BEELINE HWY
Practice Address - Street 2:SUITE D
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4800
Practice Address - Country:US
Practice Address - Phone:928-474-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC4644Medicare ID - Type Unspecified