MEDICARE: WILLIAMS CHIROPRACTIC CLINIC, LLC

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	CH10007	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH10007	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1518237445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMS CHIROPRACTIC CLINIC, LLC

Provider Business Mailing Address
First Line	:	1786 MILLS AVE.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1852
Country	:	US
Telephone Number	:	407-985-2880
Fax Number	:	407-985-2879

Provider Business Practice Location Address
First Line	:	1786 N MILLS AVE.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-1852
Country	:	US
Telephone Number	:	407-985-2880
Fax Number	:	407-985-2879

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. MARK LEE WILLIAMS
Credential	:	D.C.
Telephone Number	:	40798528800

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	01/15/2013

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