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General NPI Number Information
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NPI Number | 1609886134
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Entity Type | Individual
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Provider Name | WAITES EARL WILLIAMS JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 615 EAST FOOTHILL BLVD SUITE D
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City | SAN DIMAS
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State | CA
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Zip | 91773
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Country | US
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Telephone | 909-592-2823
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Fax | 909-394-7825
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Provider Business Mailing Address
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Address Line | POST OFFICE BOX 3176
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City | SAN DIMAS
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State | CA
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Zip | 91773
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Country | US
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Telephone | 909-592-2823
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Fax | 909-394-7825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 16160
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License Number State | CA
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