Healthcare Provider Details

I. General information

NPI: 1326517699
Provider Name (Legal Business Name): VINCENT MICHAEL WILLIAMS DC, MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W HIBISCUS BLVD
MELBOURNE FL
32901-2622
US

IV. Provider business mailing address

160 SAGECREST CIR APT 204
WEST MELBOURNE FL
32904-8665
US

V. Phone/Fax

Practice location:
  • Phone: 321-802-4521
  • Fax: 321-802-4523
Mailing address:
  • Phone: 321-802-4521
  • Fax: 321-802-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH16048
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL6116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: