Provider Demographics
NPI:1952447559
Name:WILLIAMS, DOUGLAS LAWRENCE (DC DOCTOR OF CHIROPR)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LAWRENCE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5943
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5943
Mailing Address - Country:US
Mailing Address - Phone:765-448-6489
Mailing Address - Fax:765-448-9775
Practice Address - Street 1:134 EXECUTIVE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905
Practice Address - Country:US
Practice Address - Phone:765-448-6489
Practice Address - Fax:765-448-9775
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001417A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
10787189OtherCAQH
IN184960BMedicare ID - Type Unspecified
10787189OtherCAQH