Provider Demographics
NPI:1306864137
Name:WILLIAMS, JEFFREY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
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 1:2 EAGLE CTR
Mailing Address - Street 2:STE 2
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1847
Mailing Address - Country:US
Mailing Address - Phone:618-628-0800
Mailing Address - Fax:888-753-6282
Practice Address - Street 1:2 EAGLE CTR
Practice Address - Street 2:STE 2
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1847
Practice Address - Country:US
Practice Address - Phone:618-628-0800
Practice Address - Fax:888-753-6282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor