Provider Demographics
NPI:1861719890
Name:WILLIAMS CHIROPRACTIC WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:WILLIAMS CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-882-7565
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-0818
Mailing Address - Country:US
Mailing Address - Phone:501-882-7565
Mailing Address - Fax:501-882-7561
Practice Address - Street 1:605 W DEWITT HENRY DR
Practice Address - Street 2:SUITE C
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2211
Practice Address - Country:US
Practice Address - Phone:501-882-7565
Practice Address - Fax:501-882-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T156OtherMEDICARE, PTAN
AR128716718Medicaid