Provider Demographics
NPI:1235379769
Name:WILLIAMS, RONALD O (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:O
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 1:1008 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:IL
Mailing Address - Zip Code:61270-9536
Mailing Address - Country:US
Mailing Address - Phone:815-772-7122
Mailing Address - Fax:815-734-3194
Practice Address - Street 1:1008 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-9536
Practice Address - Country:US
Practice Address - Phone:815-772-7122
Practice Address - Fax:815-734-3194
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003346111NI0013X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL098-15385-40OtherBLUE CROSS
IL038003346Medicaid
IL038003346Medicaid