Provider Demographics
NPI:1356428221
Name:WILLIAMS, RONALD GARY (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GARY
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 1:2663 44TH ST SW STE 206
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4189
Mailing Address - Country:US
Mailing Address - Phone:616-249-0380
Mailing Address - Fax:616-249-7389
Practice Address - Street 1:2663 44TH ST SW STE 206
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4189
Practice Address - Country:US
Practice Address - Phone:616-249-0380
Practice Address - Fax:616-249-7389
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU22991Medicare UPIN