Provider Demographics
NPI:1205864030
Name:WILLIAMS, BURNIE E (DC)
Entity Type:Individual
Prefix:
First Name:BURNIE
Middle Name:E
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 1:1400 PEOPLES PLAZA
Mailing Address - Street 2:#224
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:302-836-6443
Mailing Address - Fax:302-836-6443
Practice Address - Street 1:1400 PEOPLES PLAZA
Practice Address - Street 2:#224
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-836-6443
Practice Address - Fax:302-836-6443
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66181Medicare UPIN
DEWI906732Medicare ID - Type Unspecified