Provider Demographics
NPI:1356615066
Name:WILLIAMS, JEREMIAH BENJAMIN, DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:BENJAMIN, DAVID
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 1:518 SE WASHINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8236
Mailing Address - Country:US
Mailing Address - Phone:918-213-0550
Mailing Address - Fax:
Practice Address - Street 1:518 SE WASHINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8236
Practice Address - Country:US
Practice Address - Phone:918-213-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor