Healthcare Provider Details

I. General information

NPI: 1649456294
Provider Name (Legal Business Name): HANK WILLIAMS CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 MYRTLE ST STE A
LAGUNA BEACH CA
92651-1540
US

IV. Provider business mailing address

177 MYRTLE ST STE A
LAGUNA BEACH CA
92651-1540
US

V. Phone/Fax

Practice location:
  • Phone: 949-376-7895
  • Fax: 949-376-8196
Mailing address:
  • Phone: 949-376-7895
  • Fax: 949-376-8196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC29331
License Number StateCA

VIII. Authorized Official

Name: DR. HANK WILLIAMS
Title or Position: OWNER
Credential: DC
Phone: 949-376-7895