Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0104556822 | VA |
N | 111N00000X | Chiropractor | 1608 | NC |
NPI | 1003879602 |
---|---|
Provider Name | Dale Francisco Williams |
First Address | South Boston, VA 24592-2146 |
Second Address | South Boston, VA 24592-2146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 26/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T64538 | (02) | NC |