MEDICARE: DR. BRANDON MARSHALL WILLIAMS DC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2009012055	MO
2	363AS0400X	Surgical Physician Assistant		MO

General Provider Information

NPI Number	:	1134355175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON MARSHALL WILLIAMS DC, PA

Provider Business Mailing Address
First Line	:	13 WOLF CREEK DR STE 1
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2367
Country	:	US
Telephone Number	:	618-233-4458
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 WOLF CREEK DR STE 1
Second Line	:
City	:	SWANSEA
State	:	IL
Zip	:	62226-2367
Country	:	US
Telephone Number	:	618-233-4458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	10/14/2021

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