Provider Demographics
NPI:1528186756
Name:WILLIAMS, HEYWARD DAVID (DC)
Entity Type:Individual
Prefix:
First Name:HEYWARD
Middle Name:DAVID
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 1:1108 SW B AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4229
Mailing Address - Country:US
Mailing Address - Phone:580-248-8322
Mailing Address - Fax:580-248-8323
Practice Address - Street 1:1108 SW B AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4229
Practice Address - Country:US
Practice Address - Phone:580-248-8322
Practice Address - Fax:580-248-8323
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74532Medicare UPIN
OK243723203Medicare PIN