Provider Demographics
NPI:1154511731
Name:WILLIAMS CLINIC, INC
Entity Type:Organization
Organization Name:WILLIAMS CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-682-4361
Mailing Address - Street 1:PO BOX 1600
Mailing Address - Street 2:103 W. LYNN STREET
Mailing Address - City:STRYKER
Mailing Address - State:OH
Mailing Address - Zip Code:43557-1600
Mailing Address - Country:US
Mailing Address - Phone:419-682-4361
Mailing Address - Fax:419-682-4362
Practice Address - Street 1:103 W LYNN ST
Practice Address - Street 2:
Practice Address - City:STRYKER
Practice Address - State:OH
Practice Address - Zip Code:43557-1600
Practice Address - Country:US
Practice Address - Phone:419-682-4361
Practice Address - Fax:419-682-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWI9327561Medicare UPIN