Healthcare Provider Details

I. General information

NPI: 1740508258
Provider Name (Legal Business Name): JEFF WILLIAMS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44820 10TH ST W
LANCASTER CA
93534-2312
US

IV. Provider business mailing address

2220 E ROUTE 66 STE 225
GLENDORA CA
91740-7602
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-6302
  • Fax: 661-940-6083
Mailing address:
  • Phone: 626-914-5881
  • Fax: 626-914-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: