Provider Demographics
NPI:1356567150
Name:WILLIAMS, MATTHEU OWEN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEU
Middle Name:OWEN
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 1:2607 BRIDGEPORT WAY W STE 1D
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4725
Mailing Address - Country:US
Mailing Address - Phone:253-566-2225
Mailing Address - Fax:
Practice Address - Street 1:2607 BRIDGEPORT WAY W STE 1D
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4725
Practice Address - Country:US
Practice Address - Phone:253-566-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWI4950OtherREGENCE
WA117001OtherLABOR AND INDUSTRIES
WA41-2160221OtherTAX ID
WAU68249Medicare UPIN
WA117001OtherLABOR AND INDUSTRIES