Provider Demographics
NPI:1215190061
Name:THERESA M WILLIAMS
Entity Type:Organization
Organization Name:THERESA M WILLIAMS
Other - Org Name:WILLIAMS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-949-5511
Mailing Address - Street 1:23035 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5100
Mailing Address - Country:US
Mailing Address - Phone:586-949-5511
Mailing Address - Fax:586-949-8774
Practice Address - Street 1:23035 21 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5100
Practice Address - Country:US
Practice Address - Phone:586-949-5511
Practice Address - Fax:586-949-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33122Medicare UPIN
MI0E05028Medicare PIN