Provider Demographics
NPI:1225036452
Name:WILLIAMS, CYNTHIA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22737 BARTON RD
Mailing Address - Street 2:#118
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5262
Mailing Address - Country:US
Mailing Address - Phone:951-543-5226
Mailing Address - Fax:909-884-9496
Practice Address - Street 1:123 N E ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1918
Practice Address - Country:US
Practice Address - Phone:909-884-6677
Practice Address - Fax:909-884-9496
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0181720Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER