Provider Demographics
NPI:1659619351
Name:WILLIAMS, JASON DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JASON
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 1:4531 HARD SCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8561
Mailing Address - Country:US
Mailing Address - Phone:803-419-8700
Mailing Address - Fax:803-865-6760
Practice Address - Street 1:4531 HARD SCRABBLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8561
Practice Address - Country:US
Practice Address - Phone:803-419-8700
Practice Address - Fax:803-865-6760
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor