Provider Demographics
NPI:1659678456
Name:WILLIAMS, JEFFREY MAX (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MAX
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:151 N 4TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6300
Mailing Address - Country:US
Mailing Address - Phone:208-637-2225
Mailing Address - Fax:208-258-7389
Practice Address - Street 1:151 N 4TH AVE
Practice Address - Street 2:STE A
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6300
Practice Address - Country:US
Practice Address - Phone:208-637-2225
Practice Address - Fax:208-258-7389
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1473111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1679854491Medicaid
ID20000335Medicare PIN