Provider Demographics
NPI:1326070483
Name:WILLIAMS, JIMMIE DOUGLAS III (DC, PA)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:DOUGLAS
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 S MUR LEN RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1873
Mailing Address - Country:US
Mailing Address - Phone:913-764-9077
Mailing Address - Fax:913-764-8979
Practice Address - Street 1:14101 S MUR LEN RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1873
Practice Address - Country:US
Practice Address - Phone:913-764-9077
Practice Address - Fax:913-764-8979
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0103566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0001805Medicare ID - Type Unspecified