Provider Demographics
NPI:1649456294
Name:HANK WILLIAMS CHIROPRACTIC CORP
Entity type:Organization
Organization Name:HANK WILLIAMS CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-376-7895
Mailing Address - Street 1:177 MYRTLE ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1540
Mailing Address - Country:US
Mailing Address - Phone:949-376-7895
Mailing Address - Fax:949-376-8196
Practice Address - Street 1:177 MYRTLE ST STE A
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1540
Practice Address - Country:US
Practice Address - Phone:949-376-7895
Practice Address - Fax:949-376-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29331111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty