Provider Demographics
NPI:1508973496
Name:WILLIAMS, KENNETH C (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
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:PO BOX 3028
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-3028
Mailing Address - Country:US
Mailing Address - Phone:910-521-7800
Mailing Address - Fax:910-521-7893
Practice Address - Street 1:401 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8889
Practice Address - Country:US
Practice Address - Phone:910-521-7800
Practice Address - Fax:910-521-7893
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890836NMedicaid
NC2454063AMedicare ID - Type Unspecified
NC890836NMedicaid