Provider Demographics
NPI:1316013386
Name:WOMER, WILLIAM RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RICHARD
Last Name:WOMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:R
Other - Last Name:WOMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:604 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084
Mailing Address - Country:US
Mailing Address - Phone:847-526-3344
Mailing Address - Fax:847-526-3344
Practice Address - Street 1:604 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084
Practice Address - Country:US
Practice Address - Phone:847-526-3344
Practice Address - Fax:847-526-3344
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36264Medicare UPIN
316320Medicare ID - Type Unspecified