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General NPI Number Information
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NPI Number | 1114414893
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Entity Type | Organization
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Legal Business Name | WILLIAMS SPORTS CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90025-5337
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Country | US
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Telephone | 424-209-8490
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Fax | 424-253-8208
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Provider Business Mailing Address
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Address Line | 8500 FALMOUTH AVE UNIT 3316
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-8727
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Country | US
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Telephone | 310-439-2246
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Fax | 424-253-8208
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Authorized Official
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Title or Position | OWNER
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Name | DR. DUSTIN JAMES WILLIAMS
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Credential | DC
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Telephone | 424-209-8490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC31325
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License Number State | CA
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