MEDICARE: DR. THOMAS SEAN WILLIAMS DC

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	038.012897	IL

General Provider Information

NPI Number	:	1164887154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS SEAN WILLIAMS DC

Provider Business Mailing Address
First Line	:	924 W AINSLIE ST
Second Line	:	APT 1N
City	:	CHICAGO
State	:	IL
Zip	:	60640-3813
Country	:	US
Telephone Number	:	708-822-8917
Fax Number	:

Provider Business Practice Location Address
First Line	:	924 W AINSLIE ST
Second Line	:	APT 1N
City	:	CHICAGO
State	:	IL
Zip	:	60640-3813
Country	:	US
Telephone Number	:	708-822-8917
Fax Number	:

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

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/18/2015

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