Provider Demographics
NPI:1609079169
Name:GARRISON, WILLIAM JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JACK
Last Name:GARRISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:JACK
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3528 FOREST BRANCH DR APT D
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-8957
Mailing Address - Country:US
Mailing Address - Phone:813-716-5446
Mailing Address - Fax:
Practice Address - Street 1:1215 W BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4309
Practice Address - Country:US
Practice Address - Phone:813-754-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor