Provider Demographics
NPI:1740555861
Name:WILLIAMS, WESLEY ALLEN (DC)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:ALLEN
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 1:10618 HIGHWAY 178
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240-9103
Mailing Address - Country:US
Mailing Address - Phone:760-223-1555
Mailing Address - Fax:
Practice Address - Street 1:10618 HIGHWAY 178
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9103
Practice Address - Country:US
Practice Address - Phone:760-223-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor