Provider Demographics
NPI:1063519379
Name:DR. CHAD G WILLIAMS
Entity type:Organization
Organization Name:DR. CHAD G WILLIAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-228-2000
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:WAURIKA
Mailing Address - State:OK
Mailing Address - Zip Code:73573-0239
Mailing Address - Country:US
Mailing Address - Phone:580-228-2000
Mailing Address - Fax:580-228-2000
Practice Address - Street 1:104 E HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:WAURIKA
Practice Address - State:OK
Practice Address - Zip Code:73573-3075
Practice Address - Country:US
Practice Address - Phone:580-228-2000
Practice Address - Fax:580-228-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty