Healthcare Provider Details

I. General information

NPI: 1790882132
Provider Name (Legal Business Name): MERCEDES WILLIAMSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 GEORGIA ST SUITE B
LOUISIANA MO
63353-2581
US

IV. Provider business mailing address

2201 GEORGIA ST SUITE B
LOUISIANA MO
63353-2581
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5350
  • Fax: 573-754-5227
Mailing address:
  • Phone: 573-754-5350
  • Fax: 573-754-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: