Provider Demographics
NPI:1841590361
Name:WILLIAMS, MARK LEE (DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LEE
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 1:1786 N MILLS AVE.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1852
Mailing Address - Country:US
Mailing Address - Phone:407-985-2880
Mailing Address - Fax:407-985-2879
Practice Address - Street 1:1786 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1852
Practice Address - Country:US
Practice Address - Phone:407-985-2880
Practice Address - Fax:407-985-2879
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor