Provider Demographics
NPI:1245431774
Name:WILLIAMS, SHAWN P (DC, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 NEWELL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3023
Mailing Address - Country:US
Mailing Address - Phone:718-702-8756
Mailing Address - Fax:
Practice Address - Street 1:211 BELLEVUE AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1820
Practice Address - Country:US
Practice Address - Phone:718-702-8756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00635600111N00000X
NYX0109831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor