Provider Demographics
NPI:1477687358
Name:FOTIOU, WILLIAM ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:FOTIOU
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 1:19 CHRISTOPHER LN
Mailing Address - Street 2:
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2511
Mailing Address - Country:US
Mailing Address - Phone:609-702-9153
Mailing Address - Fax:
Practice Address - Street 1:502 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1420
Practice Address - Country:US
Practice Address - Phone:609-393-8603
Practice Address - Fax:609-393-1648
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor