Provider Demographics
NPI:1407876527
Name:WILLIAMS, MICHAEL DUANE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DUANE
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 1:2437 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2457
Mailing Address - Country:US
Mailing Address - Phone:812-882-2240
Mailing Address - Fax:812-882-2242
Practice Address - Street 1:2437 N 6TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2457
Practice Address - Country:US
Practice Address - Phone:812-882-2240
Practice Address - Fax:812-882-2242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001108A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU49206Medicare UPIN
IN444330Medicare ID - Type Unspecified