Provider Demographics
NPI:1801952445
Name:MOMYER, WILLIAM P (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:MOMYER
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 1:24612 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4965
Mailing Address - Country:US
Mailing Address - Phone:253-859-2373
Mailing Address - Fax:253-856-8754
Practice Address - Street 1:24612 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4965
Practice Address - Country:US
Practice Address - Phone:253-859-2373
Practice Address - Fax:253-856-8754
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA990251585 9824KEOtherREGENCE BLUE SHIELD
WA0034012OtherDEPT L&I NUMBER
WAGAB20510Medicare ID - Type Unspecified