Provider Demographics
NPI:1518359371
Name:WILLIAMS, JENNIFER MICHELE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MICHELE
Other - Last Name:MORRIS, WYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:122 E COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5302
Mailing Address - Country:US
Mailing Address - Phone:260-267-5743
Mailing Address - Fax:
Practice Address - Street 1:122 E COLLINS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5302
Practice Address - Country:US
Practice Address - Phone:260-267-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009560111N00000X
HIDC-1312111NS0005X
IN08003049A111NS0005X
CA33192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor