Healthcare Provider Details

I. General information

NPI: 1366622953
Provider Name (Legal Business Name): TAY & WILLIAMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9829 MIRA MESA BLVD
SAN DIEGO CA
92131-1005
US

IV. Provider business mailing address

9829 MIRA MESA BLVD
SAN DIEGO CA
92131-1005
US

V. Phone/Fax

Practice location:
  • Phone: 858-527-0232
  • Fax: 858-527-0233
Mailing address:
  • Phone: 858-527-0232
  • Fax: 858-527-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDC26934
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26934
License Number StateCA

VIII. Authorized Official

Name: DR. KIYEN A TAY WILLIAMS
Title or Position: PRESIDENT
Credential: DC
Phone: 858-527-0232