Provider Demographics
NPI:1629148044
Name:WILLIAMS, RUSSELL WILLIAM III (DC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:WILLIAM
Last Name:WILLIAMS
Suffix:III
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 1:6158 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:MARCY
Mailing Address - State:NY
Mailing Address - Zip Code:13403-3311
Mailing Address - Country:US
Mailing Address - Phone:315-525-6846
Mailing Address - Fax:
Practice Address - Street 1:130 LOMOND CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5951
Practice Address - Country:US
Practice Address - Phone:315-732-3400
Practice Address - Fax:315-732-4250
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor