Provider Demographics
NPI:1851301394
Name:WILLIAMS, THERESA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23035 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5100
Mailing Address - Country:US
Mailing Address - Phone:586-949-5511
Mailing Address - Fax:586-949-8774
Practice Address - Street 1:23035 21 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5100
Practice Address - Country:US
Practice Address - Phone:586-949-5511
Practice Address - Fax:586-949-8774
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E05028Medicare ID - Type Unspecified
T33122Medicare UPIN