Provider Demographics
NPI:1508903956
Name:WILLIAMS, SEAN A (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:A
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 1:12417 OCEAN GTWY
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9521
Mailing Address - Country:US
Mailing Address - Phone:410-213-8787
Mailing Address - Fax:410-213-1234
Practice Address - Street 1:12417 OCEAN GTWY
Practice Address - Street 2:UNIT 2A
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9521
Practice Address - Country:US
Practice Address - Phone:410-213-8787
Practice Address - Fax:410-213-1234
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61990802OtherBLUE CROSS RENDERING ID
MD497ACOOtherMD BC BS PROVIDER ID
MDJ034-0001OtherBLUE CHOICE ID
MD497ACOOtherMD BC BS PROVIDER ID