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General NPI Number Information
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NPI Number | 1215190061
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Entity Type | Organization
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Legal Business Name | THERESA M WILLIAMS
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 23035 21 MILE RD
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City | MACOMB
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State | MI
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Zip | 48042-5100
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Country | US
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Telephone | 586-949-5511
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Fax | 586-949-8774
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Provider Business Mailing Address
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Address Line | 23035 21 MILE RD
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City | MACOMB
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State | MI
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Zip | 48042-5100
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Country | US
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Telephone | 586-949-5511
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Fax | 586-949-8774
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. THERESA MARIE WILLIAMS
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Credential | D.C.
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Telephone | 586-949-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301005106
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License Number State | MI
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