Provider Demographics
NPI:1437157310
Name:WILLIAMS, ERIC PAUL (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W SCHWARTZ ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1550
Mailing Address - Country:US
Mailing Address - Phone:618-548-1136
Mailing Address - Fax:618-548-1136
Practice Address - Street 1:322 W SCHWARTZ ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1550
Practice Address - Country:US
Practice Address - Phone:618-548-1136
Practice Address - Fax:618-548-2058
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2010-07-13
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
IL038005584111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06182012OtherBCBS OF ILLINOIS
IL127596OtherHEALTHLINK
IL127596OtherHEALTHLINK
IL922570Medicare ID - Type Unspecified
IL350018900Medicare ID - Type UnspecifiedRR MEDICARE