Provider Demographics
NPI:1982815668
Name:WILLIAMS, BOYD
Entity Type:Individual
Prefix:DR
First Name:BOYD
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 10TH NWLN 103
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7033
Mailing Address - Country:US
Mailing Address - Phone:507-281-4878
Mailing Address - Fax:507-280-8023
Practice Address - Street 1:3632 10TH NWLN 103
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-7033
Practice Address - Country:US
Practice Address - Phone:507-281-4878
Practice Address - Fax:507-280-8023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT-39551Medicare UPIN