Provider Demographics
NPI:1154483360
Name:BYRKIT, WILLIAM NATHANIEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NATHANIEL
Last Name:BYRKIT
Suffix:JR
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 1:1280 VANDALIA STREET
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234
Mailing Address - Country:US
Mailing Address - Phone:618-344-2501
Mailing Address - Fax:618-344-2502
Practice Address - Street 1:1280 VANDALIA STREET
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234
Practice Address - Country:US
Practice Address - Phone:618-344-2501
Practice Address - Fax:618-344-2502
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06082012OtherBLUECROSS BLUESHIELD
IL038003310Medicaid
IL791350047Medicare ID - Type UnspecifiedRR
T36081Medicare UPIN
IL292570Medicare ID - Type Unspecified