Provider Demographics
NPI:1164887154
Name:WILLIAMS, THOMAS SEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SEAN
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 1:924 W AINSLIE ST
Mailing Address - Street 2:APT 1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3813
Mailing Address - Country:US
Mailing Address - Phone:708-822-8917
Mailing Address - Fax:
Practice Address - Street 1:924 W AINSLIE ST
Practice Address - Street 2:APT 1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3813
Practice Address - Country:US
Practice Address - Phone:708-822-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor