Provider Demographics
NPI:1861409161
Name:WILLIAMS, ALAN DALE (DC)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:DALE
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 1:148 TAYLOR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-6659
Mailing Address - Country:US
Mailing Address - Phone:606-487-8255
Mailing Address - Fax:606-487-8433
Practice Address - Street 1:148 TAYLOR RIDGE RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-6659
Practice Address - Country:US
Practice Address - Phone:606-487-8255
Practice Address - Fax:606-487-8433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000586Medicaid
0947701Medicare PIN
KY85000586Medicaid
0947701Medicare ID - Type Unspecified