Provider Demographics
NPI:1336637545
Name:MCMENAMEY, WILLIAM AUGUSTINE IV
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:AUGUSTINE
Last Name:MCMENAMEY
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-1149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:188 MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-1149
Practice Address - Country:US
Practice Address - Phone:203-814-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor