Provider Demographics
NPI:1164948543
Name:WILLIAMS, ZAC (DC)
Entity Type:Individual
Prefix:
First Name:ZAC
Middle Name:
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 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-1937
Mailing Address - Country:US
Mailing Address - Phone:574-773-4174
Mailing Address - Fax:574-773-5404
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-1937
Practice Address - Country:US
Practice Address - Phone:574-773-4174
Practice Address - Fax:574-773-5404
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002987A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1013618313Medicaid
IN1164948543Medicaid