Provider Demographics
NPI:1245422344
Name:WILLIAMS, SCOTTIE L (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTTIE
Middle Name:L
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 1:3160 HIGHWAY 21
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8845
Mailing Address - Country:US
Mailing Address - Phone:803-548-9091
Mailing Address - Fax:
Practice Address - Street 1:3160 HIGHWAY 21
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8845
Practice Address - Country:US
Practice Address - Phone:704-460-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor