Provider Demographics
NPI:1407057847
Name:WILLIAMS, HEIDI MELISSA (DC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MELISSA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 W 25TH ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3108
Mailing Address - Country:US
Mailing Address - Phone:216-685-9975
Mailing Address - Fax:216-685-9976
Practice Address - Street 1:1730 W 25TH ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3108
Practice Address - Country:US
Practice Address - Phone:216-685-9975
Practice Address - Fax:216-685-9976
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2388447Medicaid
OH2388447Medicaid
OHWI4039142Medicare ID - Type Unspecified