Provider Demographics
NPI:1750925525
Name:RUSSELL W WILLIAMS III, DC, PLLC
Entity type:Organization
Organization Name:RUSSELL W WILLIAMS III, DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:315-525-6846
Mailing Address - Street 1:331 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1424
Mailing Address - Country:US
Mailing Address - Phone:315-525-6846
Mailing Address - Fax:315-533-4377
Practice Address - Street 1:331 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1424
Practice Address - Country:US
Practice Address - Phone:315-525-6846
Practice Address - Fax:315-533-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty