Provider Demographics
NPI:1922098599
Name:WILLIAMS, MICHAEL A (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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 1:1332 NORWOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5560
Mailing Address - Country:US
Mailing Address - Phone:636-202-0721
Mailing Address - Fax:
Practice Address - Street 1:8600 MEXICO RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7507
Practice Address - Country:US
Practice Address - Phone:636-202-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE-006167111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4059001Medicare PIN
MOU02908Medicare UPIN