Provider Demographics
NPI:1437151149
Name:MEAD, WILLIAM NELSON (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NELSON
Last Name:MEAD
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 1:1201B S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6419
Mailing Address - Country:US
Mailing Address - Phone:910-343-9779
Mailing Address - Fax:910-343-9669
Practice Address - Street 1:1201B S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6419
Practice Address - Country:US
Practice Address - Phone:910-343-9779
Practice Address - Fax:910-343-9669
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08689OtherBLUE CROSS BLUE SHIELD NC
NC89-244565BMedicaid
NC56-1809228OtherFEDERAL TAX ID NUMBER
NC56-1809228OtherFEDERAL TAX ID NUMBER
NC244565BMedicare ID - Type Unspecified