Healthcare Provider Details

I. General information

NPI: 1235478637
Provider Name (Legal Business Name): ALLEN N WILLIAMS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35300 VAN DYKE ST
SOLDOTNA AK
99669-8601
US

IV. Provider business mailing address

P.O. BOX 220432
ANCHORAGE AK
99522
US

V. Phone/Fax

Practice location:
  • Phone: 801-953-8543
  • Fax:
Mailing address:
  • Phone: 801-953-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number336
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: