Provider Demographics
NPI:1952340580
Name:WILLIAMS, PHYLLIS ANDREA (DC)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ANDREA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:P.
Other - Middle Name:ANDREA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:685 E REMINGTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1941
Mailing Address - Country:US
Mailing Address - Phone:408-737-0730
Mailing Address - Fax:408-735-1000
Practice Address - Street 1:685 E REMINGTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1941
Practice Address - Country:US
Practice Address - Phone:408-737-0730
Practice Address - Fax:408-735-1000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0121000Medicare ID - Type Unspecified
CAT04624Medicare UPIN