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General NPI Number Information
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NPI Number | 1306053830
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Entity Type | Organization
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Legal Business Name | KURT S. WILLIAMS
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 315 N ELM ST
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City | CENTRALIA
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State | IL
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Zip | 62801-2954
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Country | US
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Telephone | 618-532-7600
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Fax | 618-532-8667
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Provider Business Mailing Address
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Address Line | 315 N ELM ST PO BOX 496
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City | CENTRALIA
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State | IL
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Zip | 62801-2954
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Country | US
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Telephone | 618-532-7600
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Fax | 618-532-8667
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Authorized Official
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Title or Position | OWNER
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Name | DR. KURT S. WILLIAMS
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Credential | D.C.
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Telephone | 618-532-7600
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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 | 038004395
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License Number State | IL
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