Provider Demographics
NPI:1295981264
Name:B E WILLIAMSON DC PC
Entity type:Organization
Organization Name:B E WILLIAMSON DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-682-0575
Mailing Address - Street 1:100 W ROOSEVELT RD
Mailing Address - Street 2:SUITE A4-104
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5260
Mailing Address - Country:US
Mailing Address - Phone:630-682-0575
Mailing Address - Fax:630-682-0581
Practice Address - Street 1:100 W ROOSEVELT RD
Practice Address - Street 2:SUITE A4-104
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5260
Practice Address - Country:US
Practice Address - Phone:630-682-0575
Practice Address - Fax:630-682-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003694261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL659260Medicare UPIN