MEDICARE: WILLIAMS FAMILY CHIROPRACTIC, PC

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	4890	CO

General Provider Information

NPI Number	:	1578754156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMS FAMILY CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	750 2ND AVE
Second Line	:
City	:	MONTE VISTA
State	:	CO
Zip	:	81144-1447
Country	:	US
Telephone Number	:	719-852-4032
Fax Number	:	719-852-3092

Provider Business Practice Location Address
First Line	:	750 2ND AVE
Second Line	:
City	:	MONTE VISTA
State	:	CO
Zip	:	81144-1447
Country	:	US
Telephone Number	:	719-852-4032
Fax Number	:	719-852-3092

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. SHANNON WILLIAMS
Credential	:
Telephone Number	:	719-852-4032

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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