Healthcare Provider Details

I. General information

NPI: 1750925525
Provider Name (Legal Business Name): RUSSELL W WILLIAMS III, DC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 ORISKANY BLVD
WHITESBORO NY
13492-1424
US

IV. Provider business mailing address

331 ORISKANY BLVD
WHITESBORO NY
13492-1424
US

V. Phone/Fax

Practice location:
  • Phone: 315-525-6846
  • Fax: 315-533-4377
Mailing address:
  • Phone: 315-525-6846
  • Fax: 315-533-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL W WILLIAMS III
Title or Position: SOLE OWNER
Credential: DC
Phone: 315-525-6846