=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568912970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IAN WILLIAMS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2016
-----------------------------------------------------
Last Update Date | 10/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 BELLEVUE WAY SE STE 202
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-6649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-378-1800
-----------------------------------------------------
Fax | 425-462-1802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 BELLEVUE WAY SE STE 202
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98004-6649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-378-1800
-----------------------------------------------------
Fax | 425-462-1802
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT IAN WILLIAMS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 425-378-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH00003453
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH60196649
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH60231990
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------