Healthcare Provider Details

I. General information

NPI: 1659678456
Provider Name (Legal Business Name): JEFFREY MAX WILLIAMS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JEFF WILLIAMS D.C.

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N 4TH AVE STE A
POCATELLO ID
83201-6300
US

IV. Provider business mailing address

151 N 4TH AVE STE A
POCATELLO ID
83201-6300
US

V. Phone/Fax

Practice location:
  • Phone: 208-637-2225
  • Fax: 208-258-7389
Mailing address:
  • Phone: 208-637-2225
  • Fax: 208-258-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1473
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIA-1473
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: