MEDICARE: DR. JENNIFER MICHELE WILLIAMS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR009560	GA
2	111NS0005X	Sports Physician Chiropractor	DC-1312	HI
3	111NS0005X	Sports Physician Chiropractor	08003049A	IN

General Provider Information

NPI Number	:	1518359371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MICHELE WILLIAMS DC

Provider Business Mailing Address
First Line	:	122 E COLLINS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5302
Country	:	US
Telephone Number	:	260-267-5743
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 E COLLINS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5302
Country	:	US
Telephone Number	:	260-267-5743
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	11/14/2018

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