Provider Demographics
NPI:1184764433
Name:WILLIAMS, MICHAEL ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
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 1:3819 KENTUCKY AVE
Mailing Address - Street 2:3819 KENTUCKY AVE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-2709
Mailing Address - Country:US
Mailing Address - Phone:317-856-0880
Mailing Address - Fax:317-856-0886
Practice Address - Street 1:3819 KENTUCKY AVE
Practice Address - Street 2:3819 KENTUCKY AVE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-2709
Practice Address - Country:US
Practice Address - Phone:317-856-0880
Practice Address - Fax:317-856-0886
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001097111N00000X
IN81000023A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000180240OtherANTHEM BCBS
IN091360Medicare ID - Type Unspecified