Provider Demographics
NPI:1831144286
Name:MCWILLIAMS, JEANNE E (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:E
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:E
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2001 52ND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-764-4901
Mailing Address - Fax:
Practice Address - Street 1:2001 52ND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-764-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05270111N00000X
IL038003521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008115279OtherBLUE CROSS BLUE SHIELD
IL038003521Medicaid
ILK31237Medicare PIN
IAT95931Medicare UPIN