Provider Demographics
NPI:1760653166
Name:WILLIAMS - ASENCIO, CHARLES E (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:WILLIAMS - ASENCIO
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 1:2061 CALLEYAGRUMO
Mailing Address - Street 2:LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-848-5599
Mailing Address - Fax:
Practice Address - Street 1:1488 CALLE MARGINAL FAGOT
Practice Address - Street 2:AVE. BOULEVARD MIGUEL POU
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-448-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR233006OtherPREFERRED HEALTH
PR50405OtherPMC
PRP-625OtherFIRST MEDICAL
PR3646OtherAMERICAN HEALTH
PR100215OtherCRUZ AZUL
PR601555OtherMMM
PR68202 WIOtherTRIPLE SSS
PR7660030OtherHUMANA
PR0068156Medicare PIN