Healthcare Provider Details

I. General information

NPI: 1528189974
Provider Name (Legal Business Name): WILLIAMS CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 ELM ST
WINSTED CT
06098-1657
US

IV. Provider business mailing address

88 ELM ST
WINSTED CT
06098-1657
US

V. Phone/Fax

Practice location:
  • Phone: 860-379-7875
  • Fax: 860-379-3171
Mailing address:
  • Phone: 860-379-7875
  • Fax: 860-379-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number000796
License Number StateCT

VIII. Authorized Official

Name: DR. MATTHEW C WILLIAMS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 860-379-7875