Provider Demographics
NPI:1285688275
Name:LOUIS WILLIAMS CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:LOUIS WILLIAMS CHIROPRACTIC CORPORATION
Other - Org Name:WILLIAMS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-676-4080
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD STE 218
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5285
Mailing Address - Country:US
Mailing Address - Phone:951-676-4080
Mailing Address - Fax:951-676-4080
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD STE 218
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5285
Practice Address - Country:US
Practice Address - Phone:951-676-4080
Practice Address - Fax:951-676-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25999111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC025990OtherBLUE SHIELD
CAZZZ04140ZOtherMEDICARE GROUP
CADC0259990Medicare PIN
CADC025990OtherBLUE SHIELD