Healthcare Provider Details

I. General information

NPI: 1922098599
Provider Name (Legal Business Name): MICHAEL A WILLIAMS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 MEXICO RD
O FALLON MO
63366-7507
US

IV. Provider business mailing address

1332 NORWOOD HILLS DR
O FALLON MO
63366-5560
US

V. Phone/Fax

Practice location:
  • Phone: 636-202-0721
  • Fax:
Mailing address:
  • Phone: 636-202-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCE-006167
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: