Provider Demographics
NPI:1710103957
Name:WILLIAMS CHIROPRACTIC CORP PC
Entity Type:Organization
Organization Name:WILLIAMS CHIROPRACTIC CORP PC
Other - Org Name:CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-448-6489
Mailing Address - Street 1:PO BOX 5943
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5943
Mailing Address - Country:US
Mailing Address - Phone:765-448-6489
Mailing Address - Fax:765-448-9775
Practice Address - Street 1:134 EXECUTIVE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4855
Practice Address - Country:US
Practice Address - Phone:765-448-6489
Practice Address - Fax:765-448-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001417A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN184960Medicare ID - Type Unspecified