Provider Demographics
NPI:1720323439
Name:WILLIAMS CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:WILLIAMS CHIROPRACTIC CLINIC, INC
Other - Org Name:DBA FAMILY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-742-4081
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:2660 HWY 140 STE D
Mailing Address - City:CATHEYS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95306-0127
Mailing Address - Country:US
Mailing Address - Phone:209-742-4081
Mailing Address - Fax:209-742-4083
Practice Address - Street 1:2660 HWY 140 STE D
Practice Address - Street 2:
Practice Address - City:CATHEYS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95306-0127
Practice Address - Country:US
Practice Address - Phone:209-742-4081
Practice Address - Fax:209-742-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC015756261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
T05911Medicare UPIN