Provider Demographics
NPI:1508526898
Name:WILLIAMS, JORDAN K
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5229 CLEMSON DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1521
Mailing Address - Country:US
Mailing Address - Phone:801-822-2673
Mailing Address - Fax:
Practice Address - Street 1:10 AVANTA WAY STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6874
Practice Address - Country:US
Practice Address - Phone:406-652-6700
Practice Address - Fax:406-294-6701
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCHI-CHI-LIC-7394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor