Healthcare Provider Details

I. General information

NPI: 1760653166
Provider Name (Legal Business Name): CHARLES E WILLIAMS - ASENCIO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 CALLE MARGINAL FAGOT AVE. BOULEVARD MIGUEL POU
PONCE PR
00716
US

IV. Provider business mailing address

2061 CALLEYAGRUMO LOS CAOBOS
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-448-7123
  • Fax:
Mailing address:
  • Phone: 787-848-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number390
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number390
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: