Provider Demographics
NPI:1740527449
Name:ANTHONY, WILLIAM WALTER (D C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALTER
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 S CLAY ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4035
Mailing Address - Country:US
Mailing Address - Phone:630-789-3345
Mailing Address - Fax:630-789-2801
Practice Address - Street 1:443 S CLAY ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4035
Practice Address - Country:US
Practice Address - Phone:630-789-3345
Practice Address - Fax:630-789-2801
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012328111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic