Provider Demographics
NPI:1679679534
Name:WILLIAMS, TRACI KIP (DC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:KIP
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 1:8450 HICKMAN RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4313
Mailing Address - Country:US
Mailing Address - Phone:515-276-9441
Mailing Address - Fax:515-253-0948
Practice Address - Street 1:8450 HICKMAN RD
Practice Address - Street 2:SUITE 14
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4313
Practice Address - Country:US
Practice Address - Phone:515-276-9441
Practice Address - Fax:515-253-0948
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23229OtherWELLMARK BLUE CROSS BLUE
IA243089OtherMIDLANDS CHOICE
IA44-00218OtherUNITEDHEALTHCARE
IAT01330Medicare UPIN
IAI8442Medicare ID - Type Unspecified
IA44-00218OtherUNITEDHEALTHCARE