Provider Demographics
NPI:1629135967
Name:WILLIAMS, BRADLEY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ALAN
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 1:111 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5419
Mailing Address - Country:US
Mailing Address - Phone:203-966-9777
Mailing Address - Fax:203-966-0778
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5419
Practice Address - Country:US
Practice Address - Phone:203-966-9777
Practice Address - Fax:203-966-0778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001042111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP420681OtherOXFORD HEALTH PLANS
CTU41692Medicare UPIN