Provider Demographics
NPI:1720182801
Name:WILLIAMS, JAMES TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TODD
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 1:16050 SOUTH U.S. 41
Mailing Address - Street 2:
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-437-1155
Mailing Address - Fax:239-437-1451
Practice Address - Street 1:16050 SOUTH U.S. 41
Practice Address - Street 2:
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-437-1155
Practice Address - Fax:239-437-1451
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 0003812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3808181-00Medicaid
FLT 85891Medicare UPIN
FL88695Medicare ID - Type Unspecified