Provider Demographics
NPI:1821084005
Name:WILLIAMS, MATTHEW CLAY
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CLAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1657
Mailing Address - Country:US
Mailing Address - Phone:860-379-7875
Mailing Address - Fax:860-379-3171
Practice Address - Street 1:88 ELM ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1657
Practice Address - Country:US
Practice Address - Phone:860-379-7875
Practice Address - Fax:860-379-3171
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000796111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000796CT04Medicare ID - Type Unspecified
CTU03152Medicare UPIN