Provider Demographics
NPI:1649284407
Name:WILLIAMS, KENNETH LEAMON (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEAMON
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 1:107 BAY BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7428
Mailing Address - Country:US
Mailing Address - Phone:850-932-1778
Mailing Address - Fax:850-934-4770
Practice Address - Street 1:107 BAY BRIDGE DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4470
Practice Address - Country:US
Practice Address - Phone:850-932-1778
Practice Address - Fax:850-934-4770
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO5184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT94462Medicare UPIN