Provider Demographics
NPI:1164644365
Name:WILLIAMS, PERRY N II (DC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:N
Last Name:WILLIAMS
Suffix:II
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 1:124 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1116
Mailing Address - Country:US
Mailing Address - Phone:859-737-5800
Mailing Address - Fax:859-737-5801
Practice Address - Street 1:124 PROFESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1116
Practice Address - Country:US
Practice Address - Phone:859-737-5800
Practice Address - Fax:859-737-5801
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000750Medicaid
KY0551101Medicare PIN
KY85000750Medicaid