Provider Demographics
NPI:1801602487
Name:WILLIAMS, JORDAN C (DC)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:C
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 1:260 MIDDLE COUNTRY RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2569
Mailing Address - Country:US
Mailing Address - Phone:631-696-4371
Mailing Address - Fax:
Practice Address - Street 1:260 MIDDLE COUNTRY RD STE 7
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2569
Practice Address - Country:US
Practice Address - Phone:631-696-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY013923111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No111NS0005XChiropractic ProvidersChiropractorSports Physician